Effects of a faculty training program on knowledge and awareness of student concussion and academic performance.

Objective The purpose of this pilot study was to determine the feasibility of implementing a concussion educational program to college faculty and to explore the effect of the program on faculty knowledge regarding concussion and the effect on learning and return to school. Methods: The study utilized a mixed method design, with a pretest and post-test to measure concussion knowledge before and after a didactic presentation on concussion and academic performance. Semi-structured interviews gathered information on faculty's perception of concussion and academic performance. Results: Faculty demonstrated improved scores on post-test knowledge assessment of concussion and academic performance. Faculty reported that they would be more likely to observe for signs of concussion in students, and would be more willing to adhere to recommendations for academic accommodations. Conclusions: The results of the study indicate that a didactic presentation on concussion and academics may be a feasible method for training college faculty.

Intercellular Adhesion Molecule-1-Induced Posttraumatic Brain Injury Neuropathology in the Prefrontal Cortex and Hippocampus Leads to Sensorimotor Function Deficits and Psychological Stress.

Intercellular adhesion molecule-1 (ICAM-1) promotes adhesion and transmigration of circulating leukocytes across the blood-brain barrier (BBB). Traumatic brain injury (TBI) causes transmigrated immunocompetent cells to release mediators [function-associated antigen (LFA)-1 and macrophage-1 antigen (Mac-1)] that stimulate glial and endothelial cells to express ICAM-1 and release cytokines, sustaining neuroinflammation and neurodegeneration. Although a strong correlation exists between TBI-mediated inflammation and impairment in functional outcome following brain trauma, the role of ICAM-1 in impairing functional outcome by inducing neuroinflammation and neurodegeneration after TBI remains inconclusive. The experimental TBI was induced in vivo by fluid percussion injury (FPI; 10 and 20 psi) in wild-type (WT) and ICAM-1-/- mice and in vitro by stretch injury (3 psi) in brain endothelial cells. We manipulate ICAM-1 pharmacologically and genetically and conducted several biochemical analyses to gain insight into the mechanisms underlying ICAM-1-mediated neuroinflammation and performed rotarod, grid-walk, sucrose preference, and light-dark tests to assess functional outcome. TBI-induced ICAM-1-mediated neuroinflammation and cell death occur via LFA-1 or Mac-1 signaling pathways that rely on oxidative stress, matrix metalloproteinase (MMP), and vascular endothelial growth factor (VEGF) pathways. The deletion or blocking of ICAM-1 resulted in a better outcome in attenuating neuroinflammation and cell death as marked by the markers such as NF-kB, IL-1ß, TNF-α, cleaved-caspase-3 (cl-caspase-3), Annexin V, and by terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL), and Trypan blue staining. ICAM-1 deletion in TBI improves sensorimotor, depression, and anxiety-like behavior with significant upregulation of norepinephrine (NE), dopamine (DA) D1 receptor (DAD1R), serotonin (5-HT)1AR, and neuropeptide Y (NPY). This study could establish the significance of ICAM-1 as a novel therapeutic target against the pathophysiology to establish functional recovery after TBI.

Occupational Therapists' Perceived Confidence in the Management of Concussion: Implications for Occupational Therapy Education.

The purposes of this study were to examine occupational therapists' perceived confidence in the treatment and assessment of patients who have sustained concussion, to determine what factors are associated with higher versus lower levels of confidence, and to determine if concussion was a topic covered in occupational therapy curricula. This study utilized an electronic questionnaire sent out to occupational therapists in all areas of practice through social media, AOTA discussion forums, and through a continuing education company. Results indicate that there is variability in occupational therapists' perceived confidence in evaluation and treatment for individuals who have sustained concussion. Chi-square analysis indicates that higher levels of perceived confidence are associated with more clinical experience and greater amounts of continuing education in the area of concussion. Occupational therapists may benefit from additional training and education in the area of concussion.

Concussion Evaluation and Management: An Osteopathic Perspective.

Concussions have been increasingly reported over the past decade, but the reported incidence likely minimizes the actual numbers of people affected. Associated symptoms include emotional, somatic, and cognitive complaints, which may be prolonged in patients with certain risk factors. Neurologic examination is necessary to exclude upper motor neuron lesions and thus the need for brain imaging. Cervical conditions are often found concurrently with head injury and displays a similar presentation to concussions. Therefore, determining symptom origin can be problematic. Neuropsychological, oculomotor, and balance evaluations expose specific deficits that can be successfully managed with rehabilitation. Osteopathic assessment of the cranium, spine, sacrum, and thorax for somatic dysfunctions allows for prudent interventions. Patients involved in sports may begin an established graduated return-to-play protocol once cleared by their physician. Concurrently, a parallel return-to-learn program, with applicable academic accommodations, is recommended.