The Use of Electroencephalography as an Informative Tool in Assisting Early Clinical Management after Sport-Related Concussion: a Systematic Review.

Sport-related concussion (SRC) is managed primarily through serial clinical evaluations throughout recovery. However, studies suggest that clinical measures may not be suitable to detect subtle alterations in functioning and are limited by numerous internal and external factors. Electroencephalography (EEG) has been used for over eight decades to discern altered function following illnesses and injuries, including traumatic brain injury. This study evaluated the associations between EEG measures and clinical presentation within three-months following SRC. A systematic review of the literature was performed in Medline, Embase, PsycINFO, CINAHL and Web of Science databases following Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines, yielding a total of 13 peer-reviewed articles. Most studies showed low to moderate bias and moderate to high quality. The majority of the existing literature on the impact of concussion within the first 3 months post-injury suggests that individuals with concussion show altered brain function, with EEG abnormalities outlasting clinical dysfunction. Of all EEG biomarkers evaluated, P300 shows the most promise and should be explored further. Despite the relatively high quality of included articles, significant limitations are still present within this body of literature, including potential conflicts of interest and proprietary algorithms, making it difficult to draw strong and meaningful conclusions on the use of EEG in the early stages of SRC. Therefore, further exploration of the relationship between EEG measures and acute clinical presentation is warranted to determine if EEG provides additional benefits over current clinical assessments and is a feasible tool in clinical settings.

Subtle long-term cognitive effects of a single mild traumatic brain injury and the impact of a three-month aerobic exercise intervention.

BACKGROUND: Although there is a growing body of literature on the impact of multiple concussions on cognitive function with aging, less is known about the long-term impact of sustaining a single mild traumatic brain injury (mTBI). Additionally, very few interventions exist to treat mTBI patients and prevent a possible accelerated cognitive decline. This study aimed to: 1) examine the long-term effects of a single mTBI on cognition in patients aged between 55 and 70 years old; and 2) evaluate the cognitive effects of an aerobic exercise program for these patients. METHODS: Thirty-five participants (average age: 58.89, SD=4.14) were assessed using neuropsychological tests. Among them, 18 hadsustained a mTBI two to seven years earlier. Significant differences in information processing speed, executive function and visual memory were found between controls and mTBI patients. Sixteen of the mTBI patients then engaged in a 12-week physical exercise program. They were divided into equivalent groups: 1) aerobic training (cycle ergometers); or 2) stretching exercises. The participants' cardiopulmonary fitness (VO2max) was evaluated pre- and postintervention and neuropsychological tests were re-administered postintervention. RESULTS: Participants from the aerobic group significantly improved their fitness compared to the stretching group. However, no between-group difference was found on neuropsychological measures postintervention. CONCLUSIONS: In summary, this study shows long-term cognitive effects of mTBI in late adulthood patients. Moreover, the controlled, 12-week aerobic exercise program did not lead to cognitive improvements in our small mTBI sample. Lastly, future directions in optimizing mTBI intervention are discussed.

Effects of Repeated Concussions and Sex on Early Processing of Emotional Facial Expressions as Revealed by Electrophysiology.

OBJECTIVES: Concussions affect the processing of emotional stimuli. This study aimed to investigate how sex interacts with concussion effects on early event-related brain potentials (ERP) measures (P1, N1) of emotional facial expressions (EFE) processing in asymptomatic, multi-concussion athletes during an EFE identification task. METHODS: Forty control athletes (20 females and 20 males) and 43 multi-concussed athletes (22 females and 21 males), recruited more than 3 months after their last concussion, were tested. Participants completed the Beck Depression Inventory II, the Beck Anxiety Inventory, the Post-Concussion Symptom Scale, and an Emotional Facial Expression Identification Task. Pictures of male and female faces expressing neutral, angry, and happy emotions were randomly presented and the emotion depicted had to be identified as fast as possible during EEG acquisition. RESULTS: Relative to controls, concussed athletes of both sex exhibited a significant suppression of P1 amplitude recorded from the dominant right hemisphere while performing the emotional face expression identification task. The present study also highlighted a sex-specific suppression of the N1 component amplitude after concussion which affected male athletes. CONCLUSIONS: These findings suggest that repeated concussions alter the typical pattern of right-hemisphere response dominance to EFE in early stages of EFE processing and that the neurophysiological mechanisms underlying the processing of emotional stimuli are distinctively affected across sex. (JINS, 2018, 24, 673-683).

How do infants recognize joint attention?

The emergence of joint attention is still a matter of vigorous debate. It involves diverse hypotheses ranging from innate modules dedicated to intention reading to more neuro-constructivist approaches. The aim of this study was to assess whether 12-month-old infants are able to recognize a "joint attention" situation when observing such a social interaction. Using a violation-of-expectation paradigm, we habituated infants to a "joint attention" video and then compared their looking time durations between "divergent attention" videos and "joint attention" ones using a 2 (familiar or novel perceptual component)×2 (familiar or novel conceptual component) factorial design. These results were enriched with measures of pupil dilation, which are considered to be reliable measures of cognitive load. Infants looked longer at test events that involved novel speaker and divergent attention but no changes in infants' pupil dilation were observed in any conditions. Although looking time data suggest that infants may appreciate discrepancies from expectations related to joint attention behavior, in the absence of clear evidence from pupillometry, the results show no demonstration of understanding of joint attention, even at a tacit level. Our results suggest that infants may be sensitive to relevant perceptual variables in joint attention situations, which would help scaffold social cognitive development. This study supports a gradual, learning interpretation of how infants come to recognize, understand, and participate in joint attention.

Impact of BDNF Val66Met polymorphism on olfactory functions of female concussed athletes.

BACKGROUND: Concussions exert persistent effects on asymptomatic athletes, especially women. Among chief mechanisms of concussion recovery are alterations of neuronal plasticity. Olfactory function, often impaired following a concussion, greatly involves plasticity and, therefore, appears as a good candidate to study the deleterious effects of concussions. The BDNF Val66Met polymorphism (BDNFMet), which reduces availability of BDNF in the brain, has surprisingly been associated with better recovery following concussion. OBJECTIVE: This study examines the mediating effect of BDNFMet on olfactory functions in asymptomatic concussed female athletes. METHODS: Participants, 105 female university athletes, were divided into four groups based on their history of concussion (Concussion/No concussion) and BDNF polymorphism (BDNF Val66Val/Val66Met). Odour threshold, discrimination and identification were measured using the Sniffin' Sticks Inventory Test. RESULTS: Concussed female BDNFMet athletes performed significantly better than BDNFVal counterparts on threshold (F(1, 34) = 4.73, p < 0.05), discrimination (F(1, 52) = 5.36, p < 0.05), identification tests (F(1, 52) = 5.65, p < 0.05) and total olfactory scores (F(1, 34) = 9.54, p < 0.05). CONCLUSION: These results support a genotypic effect of the BDNF Val66Met polymorphism on long-term olfactory function following a concussion in young female athletes.

Electrophysiological correlates of motor sequence learning.

BACKGROUND: The Error-related negativity (ERN) is a component of the event-related brain potentials elicited by error commission. The ERN is thought to reflect cognitive control processes aiming to improve performance. As previous studies showed a modulation of the ERN amplitude throughout the execution of a learning task, this study aims to follow the ERN amplitude changes from early to late learning blocks in relation with concomitant motor sequence learning using a serial reaction time (SRT) task. Twenty-two healthy participants completed a SRT task during which continuous EEG activity was recorded. The SRT task consists of series of stimulus-response pairs and involves motor learning of a repeating sequence. Learning was computed as the difference in mean response time between the last sequence block and the last random blocks that immediately follows it (sequence-specific learning). Event-related potentials were analysed to measure ERN amplitude elicited by error commission. RESULTS: Mean ERN amplitude difference between the first four learning blocks and the last four learning blocks of the SRT task correlated significantly with motor sequence learning as well as with overall response time improvement, such that those participants whose ERN amplitude most increased through learning blocks were also those who exhibited most SRT task improvements. In contrast, neither sequence-specific learning nor overall response time improvement across learning blocks were found to be related to averaged ERN amplitude from all learning blocks. CONCLUSION: Findings from the present study suggest that the ERN amplitude changes from early to late learning blocks occurring over the course of the SRT task, as opposed to the averaged ERN amplitude from all learning blocks, is more closely associated with learning of a motor sequence. These findings propose an improved electrophysiological marker to index change in cognitive control efficiency during motor sequence learning.

Long-term attenuated electrophysiological response to errors following multiple sports concussions.

This study extracted the error-related negativity (ERN) waveform component recorded from a visual-spatial attention and a visual short-term memory task to assess rigorously the long-term and cumulative effects of concussions on evaluative processes of cognitive control related to performance monitoring. This study demonstrates that, relative to control athletes, multiply concussed athletes show significant ERN amplitude reduction elicited by error generation. These cumulative effects of concussions on ERN amplitude were found in two distinct experimental paradigms designed to solicit concussion-sensitive cognitive abilities such as attention and short-term memory. This suggests that the mechanisms that contribute to the evaluation of cognitive performance may be significantly affected following multiple concussions even in low-conflict situations.

Pupil diameter measurement errors as a function of gaze direction in corneal reflection eyetrackers.

Pupil dilation is a useful, noninvasive technique for measuring the change in cognitive load. Since it is implicit and nonverbal, it is particularly useful with preverbal or nonverbal participants. In cognitive psychology, pupil dilation is most often measured by corneal reflection eye-tracking devices. The present study investigates the effect of gaze position on pupil size estimation by three common eye-tracking systems. The task consisted of a simple object pursuit situation, as a sphere rotated around the display screen. Systematic errors of pupil size estimation were found with all three systems. Implications for task-elicited pupillometry, especially for gaze-contingent studies such as object tracking or reading, are discussed.