Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-02T19:16:43.782Z Has data issue: false hasContentIssue false
  • English
  • Français

Identifying Trends of Dysautonomia Signs and Symptoms Associated with Protracted Concussion Recovery during the Buffalo Concussion Treadmill Test: A Retrospective Study

Published online by Cambridge University Press:  25 March 2022

Lauren Ziaks Open the ORCID record for Lauren Ziaks [Opens in a new window] ,
Jenna Tucker Open the ORCID record for Jenna Tucker [Opens in a new window] ,
Thomas Koc Jr ,
Alexa Schaefer  and
Kristina Hanson
Lauren Ziaks*
Affiliation:
Intermountain Rehabilitation Services, Park City Hospital, Park City, UT, USA
Jenna Tucker
Affiliation:
School of Physical Therapy, Kean University, Union, NJ, USA
Thomas Koc Jr
Affiliation:
School of Physical Therapy, Kean University, Union, NJ, USA
Alexa Schaefer
Affiliation:
School of Physical Therapy, Kean University, Union, NJ, USA
Kristina Hanson
Affiliation:
Intermountain Rehabilitation Services, Park City Hospital, Park City, UT, USA
*
*Corresponding author. Email: [email protected]
Get access

Abstract

Objective:

To identify trends of provoked dysautonomia signs and symptoms during the Buffalo Concussion Treadmill Test (BCTT).

Subjects:

This is a retrospective cohort study of 101 patient charts post-concussion who were screened for suspected dysautonomia.

Methods:

Patients with suspected dysautonomia were assessed for exercise intolerance using a BCTT. Symptoms and rate of perceived exertion were recorded on a standardized form. Digital pulse oximetry was used to collect heart rate (HR) and oxygen saturation. Descriptive analyses were conducted on BCTT results.

Results:

Of 101 patient charts, 57 were excluded from analysis, including four patients who completed the BCTT by asymptomatically reaching the target HR zone for their estimated HR max. The remaining 44 patients demonstrated: 35 (79.5%) poor HR stabilization defined as a drop or plateau in HR during exercise, 28 (63.8%) exacerbated concussion symptoms, 13 (29.5%) autonomic nervous system response such as hot flushed sensation, 12 (27.3%) rebound symptoms during recovery phases, and 8 (18.2%) desaturation of 90% or below. The mean delta (80% expected HR max – 80% achieved HR max) on the initial test was 80.66 (± 23.08) beats per minute.

Conclusions:

This study is the first to identify trends of signs and symptoms during the BCTT in an expanded population with suspected dysautonomia after concussion. Future studies are indicated to validate these findings and contribute to development of modified termination criteria for the BCTT in individuals with suspected dysautonomia associated with protracted concussion recovery.

Keywords

Concussiondysautonomiaexercise intoleranceevaluation
Type
Articles
Information
Brain Impairment , First View , pp. 1 - 10
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of Australasian Society for the Study of Brain Impairment

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Borg, G. (1998). Borg’s Perceived Exertion and Pain Scales. Champaign, IL: Human Kinetics.Google Scholar
Callaway, C., & Kosofsky, B. E. (2019). Autonomic dysfunction following mild traumatic brain injury. Current Opinion in Neurology, 32(6), 802–807. doi: 10.1097/WCO.0000000000000751 Google ScholarPubMed
Cassidy, J.D., Carroll, L.J., Peloso, P.M., Borg, J., von Holst, H., Holm, L., & Kraus, J. (2004). Incidence, risk factors and prevention of mild traumatic brain injury: Results of the WHO collaborating centre task force on mild traumatic brain injury. Journal of Rehabilitation Medicine, 36(1), 28–60. doi: 10.1080/16501960410023732,Google Scholar
Centers for Disease Control and Prevention. Traumatic Brain Injury & Concussion: Get the Facts. Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/traumaticbraininjury/get_the_facts.html Google Scholar
Chizuk, H. M., Willer, B. S., Horn, E. C., Haider, M. N., & Leddy, J. J. (2021). Sex differences in the Buffalo Concussion Treadmill Test in adolescents with acute sport-related concussion. Journal of Science and Medicine in Sport, 24(9), 876–880. doi: 10.1016/j.jsams.2021.04.005 Google ScholarPubMed
Cleveland Clinic Medical Professionals (2020). Dysautonomia. Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/diseases/6004-dysautonomia Google Scholar
Collins, M. W., Kontos, A. P., Reynolds, E., Murawski, C. D., & Fu, F. H. (2014). A comprehensive, targeted approach to the clinical care of athletes following sport-related concussion. Knee Surgery, Sports Traumatology, Arthroscopy, 22(2), 235–246. doi: 10.1007/s00167-013-2791-6 Google Scholar
DeMeulenaere, S. (2007). Pulse oximetry: Uses and limitations. The Journal for Nurse Practitioners, 3(5), 312–317. doi: 10.1016/j.nurpra.2007.02.021 Google Scholar
Esterov, D., & Greenwald, B. D. (2017). Autonomic dysfunction after mild traumatic brain injury. Brain Sciences, 7(8), 100. doi: 10.3390/brainsci7080100 Google ScholarPubMed
Franco, F. A. (2007). Cerebral autoregulation and syncope. Progress in Cardiovascular Diseases, 50(1), 49–80. doi: 10.1016/j.pcad.2007.01.001 Google Scholar
Gordan, R., Gwathmey, J. K., & Xie, L. H. (2015). Autonomic and endocrine control of cardiovascular function. World Journal of Cardiology, 7(4), 204–214. doi: 10.4330/wjc.v7.i4.204 Google ScholarPubMed
Haider, M. N., Johnson, S. L., & Mannix, R. (2019). The Buffalo Concussion Bike Test for concussion assessment in adolescents. Sports Health: A Multidisciplinary Approach, 11(6), 492–497. doi: 10.1177/1941738119870189 Google ScholarPubMed
Haider, M. N., Leddy, J. J., Wilber, C. G., Viera, K. B., Bezherano, I., Wilkins, K. J., …Willer, B.S. (2019). The predictive capacity of the buffalo concussion treadmill test after sport-related concussion in adolescents. Frontiers in Neurology, 10(1), 395. doi: 10.3389/fneur.2019.00395,Google ScholarPubMed
Iverson, G. L., Brooks, B. L., Collins, M. W., & Lovell, M. R. (2006). Tracking neuropsychological recovery following concussion in sport. Brain Injury, 20(3), 245–252. doi: 10.1080/02699050500487910 Google ScholarPubMed
Kontos, A. P., Sufrinko, A., Sandel, N., Emami, K., & Collins, M. W. (2019). Sport-related concussion clinical profiles: Clinical characteristics, targeted treatments, and preliminary evidence. Current Sports Medicine Reports, 18(3), 82–92. doi: 10.1249/JSR.0000000000000573 Google ScholarPubMed
Kozlowski, K. F., Graham, J., Leddy, J. J., Devinney-Boymel, L., & Willer, B. S. (2013). Exercise intolerance in individuals with post concussion syndrome. Journal of Athletic Training, 48(5), 627–635. doi: 10.4085/1062-6050-48.5.02 Google Scholar
Leddy, J. J., Baker, J.G., Haider, M.N., Hinds, A., & Willer, B. (2017). A physiological approach to prolonged recovery from sport-related concussion. Journal of Athletic Training, 52(3), 299–308. doi: 10.4085/1062-6050-51.11.08 Google ScholarPubMed
Leddy, J. J., Kozlowski, K., Donnelly, J. P., Pendergast, D. R., Epstein, L. H., & Willer, B. A. (2010). A preliminary study of subsymptom threshold exercise training for refractory post-concussion syndrome. Clinical Journal of Sport Medicine, 20(1), 21–27. doi: 10.1097/JSM.0b013e3181c6c22c Google ScholarPubMed
Leddy, J. J., & Willer, B. (2013). Use of graded exercise testing in concussion and return-to-activity management. Current Sports Medicine Reports, 12(6), 370–376. doi: 10.1249/JSR.0000000000000008 Google ScholarPubMed
McCrory, P., Meeuwisse, W., Aubry, M., Cantu, B., Dvorak, J., Echemendia, R. J., …Tator, C.H. (2013). Consensus statement on concussion in sport--the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Clinical Journal of Sport Medicine, 23(2), 89–117. doi: 10.1097/JSM.0b013e31828b67cf,Google Scholar
Miranda, N. A., Boris, J. R., Kouvel, K. M., & Stiles, L. (2018). Activity and exercise intolerance after concussion: Identification and management of postural orthostatic tachycardia syndrome. Journal of Neurologic Physical Therapy, 42(3), 163–171. doi: 10.1097/NPT.0000000000000231 Google ScholarPubMed
National Institute of Neurological Disorders and Stroke (2019). Dysautonomia Information Page. National Institute of Neurological Disorders and Stroke. Retrieved from https://www.ninds.nih.gov/Disorders/All-Disorders/Dysautonomia-Information-Page Google Scholar
Nelson, L.D., Temkin, N.R., Dikmen, S., Barber, J., Giacino, J.T., Yuh, E., …Zafonte, R. (2019). Recovery after mild traumatic brain injury in patients presenting to US level I trauma centers: A transforming research and clinical knowledge in traumatic brain injury (TRACK-TBI) study. JAMA Neurology, 76(9), 1049–1059. doi: 10.1001/jamaneurol.2019.1313,Google ScholarPubMed
Numminen, H. J. (2011). The incidence of traumatic brain injury in an adult population – how to classify mild cases? European Journal of Neurology, 18(3), 460–464. doi: 10.1111/j.1468-1331.2010.03179.x Google Scholar
Pertab, J. L., Merkley, T. L., Cramond, A. J., Cramond, K., Paxton, H., & Wu, T. (2018). Concussion and the autonomic nervous system: An introduction to the field and the results of a systematic review. NeuroRehabilitation, 42(4), 397–427. doi: 10.3233/NRE-172298 Google Scholar
Peterson, A. B., Zhou, H., Thomas, K. E., & Daugherty, J. (2021). Surveillance report of traumatic brain injury-related hospitalizations and deaths by age group, sex, and mechanism of injury - United States 2016-2017. Retrieved from https://www.cdc.gov/traumaticbraininjury/pdf/TBI-surveillance-report-2016-2017-508.pdf Google Scholar
Quatman-Yates, C. C., Hunter-Giordano, A., Shimamura, K. K., Landel, R., Alsalaheen, B. A., Hanke, T. A., & McCulloch, K. L. (2020). Physical therapy evaluation and treatment after concussion/mild traumatic brain injury. Journal of Orthopaedic & Sports Physical Therapy, 50(4), CPG1–CPG73. doi: 10.2519/jospt.2020.0301 Google ScholarPubMed
Thompson, J. W. G., & Hagedorn, D. (2012). Multimodal analysis: New approaches to the concussion conundrum. Journal of Clinical Sport Psychology, 6(1), 22–46. doi: 10.1123/jcsp.6.1.22 Google Scholar
Tindle, J., & Tadi, P. (2020). Parasympathetic Nervous System. Neuroanatomy. Treasure Island, FL: StatPearls Publishing.Google Scholar
Worley, M. L., OʼLeary, M. C., Sackett, J. R., Schlader, Z. J., Willer, B., Leddy, J. J., & Johnson, B. D. (2021). Preliminary evidence of orthostatic intolerance and altered cerebral vascular control following sport-related concussion. Frontiers in Neurology, 12(1), 620757. doi: 10.3389/fneur.2021.620757 Google ScholarPubMed