Salivary MicroRNA as a Concussion Biomarker and the Implications for Athletic Trainers\u27 Practices

Many concussions are sustained globally each year; however, research suggests that a large number may go undiagnosed due to a reliance on subjective information from patients and limitations of current objective measures. Recently, efforts have been focused on identifying clinical biomarkers of concussions, including salivary microRNA (miRNA), to improve healthcare professionals’ concussion management practices. Even if salivary miRNA were shown to be a valid and reliable measure for managing concussions, healthcare professionals, such as athletic trainers (ATs), must be familiar with the tool and have positive attitudes toward the implementation into clinical practice. Therefore, the purpose of this dissertation was to better understand salivary miRNA as a concussion biomarker through three studies. In our first study, we performed a scoping review to identify specific salivary miRNA that have demonstrate potential in acting as a diagnostic or prognostic indicator of concussions. Overall, we found forty-nine salivary miRNA across nine studies throughout the literature. Of those forty-nine, thirty-four show potential for being a concussion diagnostic marker and twenty-one correlated to multiple concussions or symptom trends. Of those identified, five were identified in multiple studies. As previously stated, even if identified as a valid and reliable tool for concussion management, healthcare professionals such as ATs should demonstrate familiarity with these tools and show positive attitudes toward the implementation into clinical practice. Therefore, the second study of this dissertation aimed to evaluate ATs familiarity with biomarkers of concussion and their attitudes toward the future implementation into clinical practice. Overall, the results of this study indicated that ATs self-reported a lack of familiarity with current literature surrounding the use of biomarkers for concussion management but a large majority self-reported positive attitudes towards the future implementation of such a tool into clinical practice. Lastly, to address a limitation for the application of salivary miRNA as a concussion biomarker, we aimed to evaluate the effects of one NCAA Division I football season. In this study, we found that although simple inferential statistics revealed no significant differences between pre- and post-season expression of salivary miRNA, further analysis through intraclass correlation coefficient statistics revealed a lack of reliability in each of the six target salivary miRNA. Although these target miRNA did not demonstrate reliability from pre- to post-season, sub-analyses revealed a ratio of two miRNA that showed high sensitivity when identifying concussed individuals. Overall, research should continue to evaluate the potential for salivary miRNA to act as a concussion biomarker by evaluating other target miRNA

Implementation of an Evidence-Based Process for the Management of Concussions in Adolescent Patients for a Primary Care Office

The number of recreation and sports-related concussions (SRC) are estimated at 3.8 million every year in the United States. Recently, widespread media attention has been paid to concussion, and with this there has been a rise in adolescents with SRC seeking health care. Primary care providers are often the first to evaluate and provide treatment for adolescents with concussion. Despite the abundance of literature on concussions, there has been little empirical data to support management practices for this patient population. The purpose of the project was to provide an evidence-based process along with a clinical decision support tool to the providers of a primary care office. The main objective was to improve the confidence in primary care providers’ abilities to evaluate and manage adolescents presenting with a concussion with the most up-to-date clinical guidelines and recommendations. This included increasing confidence in recommending return to play and return to learn guidelines to patients and families. All of these objectives were met after the completion of an educational presentation on the evidencebased process

EFFECTS OF A SCRIPTED ONLINE VIDEO ON SCHOOL NURSE PERCEPTIONS OF CONCUSSION MANAGEMENT

Media attention surrounding the increased rates and serious consequences of concussions among American youths has instigated the passage of laws in all fifty states requiring improved management of concussions and the development of programs, such as the Center for Disease Control and Prevention, Heads Up to Concussion. Progress has been reported in the efficacy of concussion diagnosis and return-to-play decisions. However, there has been less progress in managing the protocols for cognitive rest and return-to-classroom. The purpose of this study was to identify significant stakeholders and factors that could improve management of cognitive rest and return-to-classroom protocols in high school students. A multidisciplinary concept analysis identified cognitive rest as a key component of concussion management. A descriptive pilot study, based upon the Theory of Planned Behavior, was conducted to explore the norms in concussion management and perceptions of school nurses in Texas. A new instrument, The Schneider Concussion Care Survey was developed and tested. The results of the pilot study were also employed to develop a study that tested the effect of a video modeling a conversation between a school nurse and a school principal, suggesting the development of a concussion care management team. Although the results for the intervention were statistically non-significant, the study identified study variables that affected the intention of school nurses in return-to-learn management and supported the Decomposed Theory of Planned Behavior. The overall results supported the need for further research among stakeholders in concussion management in order to impact the health of concussed students

Multi-directional dynamic model for traumatic brain injury detection

Traumatic brain injury (TBI) is a complex injury that is hard to predict and diagnose, with many studies focused on associating head kinematics to brain injury risk. Recently, there has been a push towards using computationally expensive finite element (FE) models of the brain to create tissue deformation metrics of brain injury. Here, we developed a 3 degree-of-freedom lumped-parameter brain model, built based on the measured natural frequencies of a FE brain model simulated with live human impact data, to be used to rapidly estimate peak brain strains experienced during head rotational accelerations. On our dataset, the simplified model correlates with peak principal FE strain by an R2 of 0.80. Further, coronal and axial model displacement correlated with fiber-oriented peak strain in the corpus callosum with an R2 of 0.77. Using the maximum displacement predicted by our brain model, we propose an injury criteria and compare it against a number of existing rotational and translational kinematic injury metrics on a dataset of head kinematics from 27 clinically diagnosed injuries and 887 non-injuries. We found that our proposed metric performed comparably to peak angular acceleration, linear acceleration, and angular velocity in classifying injury and non-injury events. Metrics which separated time traces into their directional components had improved deviance to those which combined components into a single time trace magnitude. Our brain model can be used in future work as a computationally efficient alternative to FE models for classifying injuries over a wide range of loading conditions.Comment: 10 figures, 3 table

'It Isn't My Area.' Coaches' Awareness of Concussion Protocols in Scottish Youth Football

This paper discusses an externally-funded project into Scottish coaches’ awareness of the sports concussion prevention initiative, If in Doubt, Sit Them Out. It explores the short-term risks of concussion to youth participants in particular before analysing the data from interviews with ten coaches of girls’ football. The coaches’ apparent lack of awareness of the policy are highlighted and the possibility that the different resources in girls’ and boys’ football, and between girls’ performance and girls’ recreational participation, might impact on injury recognition and treatment, are explored. The paper highlights the need for further research into those areas, and the need to immediately address the apparently low levels of awareness of If in Doubt. With that in mind, proposals for both immediate and longer-term reform for its dissemination are introduced