Sports psychiatry and medical views on mild traumatic brain injury in competitive sport: a current review and recommendations

Head injuries are common in competitive and recreational sport. Nomenclature, though inconsistent, identifies mild traumatic brain injury (mTBI) based on acute diagnostic criteria, whereas a sport-related concussion (SRC) is event-related and specific to mTBI experienced while participating in athletic activity. The effects of SRC are often neurological, neuropsychological and/or psychiatric with a variety of symptoms. Different organizations categorize these symptoms differently and this variance demonstrates that no uniform clinical classification system has been agreed upon. Diagnosis of SRC is based on clinical examination. Numerous symptom checklists and assessments are available for clinical diagnosis, but their validity is somewhat limited. There is increasing awareness regarding the psychiatric deficits associated with SRC and the potential for developing post-concussion syndrome (PCS). In addition to complex, causal SRC-associated symptoms, reactive psychological complaints may also occur, as well as social mistreatment on recovery from SRC. Pre-existing mental health conditions are associated with an increased risk for developing PCS. This often necessitates the implementation of psychiatric or psychotherapeutic care after SRC. As with mTBI and SRC, no standardized classification has been established for PCS. Multi-stage rehabilitation strategies can help injured athletes navigate a successful recovery and prevent premature return to play. Further research on the utility of psychotherapy, psychopharmacotherapy, and exercise therapy of PCS is needed. Key Words: Concussion, Mental Health, Post-Concussion Syndrome, Interdisciplinarit

THE EFFECT OF CHRONIC PASSIVE HEAT THERAPY ON FOREARM REACTIVE HYPEREMIA

Endothelial and microvascular function are important elements of overall cardiovascular health. Dysfunction in either or both is predictive of future cardiovascular events, thus preventing or minimizing the degree of dysfunction is critical to constraining the risk of such events. Reactive hyperemia is a transient increase in blood flow that occurs following a period of ischemia (e.g. arterial occlusion) and is indicative of microvascular health. Regular physical exercise is critical as a preventive measure in maintaining the capacity for reactive hyperemia; however, consistent dedication to regular exercise regimens is difficult or impossible for some people. Recent evidence suggests that chronic passive heat therapy (CHT) may result in improvements to cardiovascular health similar to that of exercise. PURPOSE: To examine the effects of 8 weeks of CHT on forearm post-occlusive reactive hyperemia. METHODS: Five, young, healthy and able-bodied university students (21 ± 1 years) underwent hot water immersion 4-5 times per week with a goal of maintaining a rectal temperature of 38.5°C for 1 hour per session for 8 weeks (36 sessions total). Before and after the 8 weeks of CHT, brachial artery blood flow was measured via Doppler ultrasonography for 3 minutes following a 5-minute forearm arterial occlusion. Data are presented as mean ± SE vascular conductance (VC, blood flow divided by mean arterial pressure). RESULTS: In preliminary subjects, change in peak VC from baseline, indicative of microvascular structural changes, increased following CHT from 1.77 ± 0.24 to 2.26 ± 0.20 ml/min/mmHg (p = 0.09) and area-under-the-curve of the hyperemic response, indicative of improvements in endothelial function, increased from 59.7 ± 9.0 to 111.9 ± 13.0 sec.ml/min/mmHg (p = 0.11). CONCLUSION: CHT appears to produce structural and functional changes in the microvasculature comparable to that of exercise training, and could potentially serve as an alternative to exercise for improving cardiovascular health