Developing Brain Vital Signs: Initial Framework for Monitoring Brain Function Changes over Time

Clinical assessment of brain function relies heavily on indirect behavior-based tests. Unfortunately, behavior-based assessments are subjective and therefore susceptible to several confounding factors. Event-related brain potentials (ERPs), derived from electroencephalography (EEG), are often used to provide objective, physiological measures of brain function. Historically, ERPs have been characterized extensively within research settings, with limited but growing clinical applications. Over the past 20 years, we have developed clinical ERP applications for the evaluation of functional status following serious injury and/or disease. This work has identified an important gap: the need for a clinically accessible framework to evaluate ERP measures. Crucially, this enables baseline measures before brain dysfunction occurs, and might enable the routine collection of brain function metrics in the future much like blood pressure measures today. Here, we propose such a framework for extracting specific ERPs as potential “brain vital signs.” This framework enabled the translation/transformation of complex ERP data into accessible metrics of brain function for wider clinical utilization. To formalize the framework, three essential ERPs were selected as initial indicators: (1) the auditory N100 (Auditory sensation); (2) the auditory oddball P300 (Basic attention); and (3) the auditory speech processing N400 (Cognitive processing). First step validation was conducted on healthy younger and older adults (age range: 22–82 years). Results confirmed specific ERPs at the individual level (86.81–98.96%), verified predictable age-related differences (P300 latency delays in older adults, p < 0.05), and demonstrated successful linear transformation into the proposed brain vital sign (BVS) framework (basic attention latency sub-component of BVS framework reflects delays in older adults, p < 0.05). The findings represent an initial critical step in developing, extracting, and characterizing ERPs as vital signs, critical for subsequent evaluation of dysfunction in conditions like concussion and/or dementia

Proceedings from the Ice Hockey Summit III: Action on Concussion

The Ice Hockey Summit III provided updated scientific evidence on concussions in hockey to inform these five objectives: 1) describe sport-related concussion (SRC) epidemiology, 2) classify prevention strategies, 3) define objective, diagnostic tests, 4) identify treatment, and 5) integrate science and clinical care into prioritized action plans and policy. Our action plan evolved from 40 scientific presentations. The 155 attendees (physicians, athletic trainers, physical therapists, nurses, neuropsychologists, scientists, engineers, coaches, and officials) voted to prioritize these action items in the final Summit session. 1) Establish a national and international hockey data base for SRC at all levels, 2) eliminate body checking in Bantam youth hockey games, 3) expand a behavior modification program (Fair Play) to all youth hockey levels, 4) enforce game ejection penalties for fighting in Junior A and professional hockey leagues, 5) establish objective tests to diagnose concussion at point of care (POC), and 6) mandate baseline testing to improve concussion diagnosis for all age groups. Expedient implementation of the Summit III prioritized action items is necessary to reduce the risk, severity, and consequences of concussion in the sport of ice hockey

fMRI BOLD signal changes in elite swimmers while viewing videos of personal failure

Athletes who fail are susceptible to negative affect (NA) and impaired future performance. Functional magnetic resonance imaging (fMRI) studies have identified prefrontal, anterior cingulate, and limbic activations following negative mood provocation. Little is known about the neural correlates of negative self-reference (SR), especially in athletes. Even less is known about the neural correlates of the effects of cognitive intervention (CI) in modifying negative SR and NA in this population. In an fMRI study, 13 athletes watched a video of their own career-threatening defeat in two controlled blocks. Between fMRI blocks, they received a 20-min CI designed to assist in event reappraisal and planning for future performance. Relative increases post-CI were seen in premotor (BA6) and sensorimotor (BA4/1) cortices. Correlated with mood ratings, relatively higher pre-CI levels were seen in the ventromedial prefrontal cortex, the right dorsomedial prefrontal cortex (PFC; BA10), the right dorsolateral PFC (BA45), the anterior cingulate, and the right parahippocampus. CI may counteract the detrimental effects of NA and negative SR on premotor and motor activity.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/83878/1/fMRI-BOLD-signal-changes-in-elite-swimmers-while-viewing-videos-of-personal-failure.pd

Proceedings from the Ice Hockey Summit III: Action on Concussion

Objectives The Ice Hockey Summit III provided updated scientific evidence on concussions in hockey to inform these five objectives: (1) describe sport related concussion (SRC) epidemiology, (2) classify prevention strategies, (3) define objective, diagnostic tests, (4) identify treatment and (5) integrate science and clinical care into prioritized action plans and policy. Methods Our action plan evolved from 40 scientific presentations. The 155 attendees (physicians, athletic trainers, physical therapists, nurses, neuropsychologists, scientists, engineers, coaches and officials) voted to prioritize these action items in the final Summit session. Results (1) establish a national and international hockey data base for SRCs at all levels; (2) eliminate body checking in Bantam youth hockey games; (3) expand a behavior modification program (Fair Play) to all youth hockey levels; (4) enforce game ejection penalties for fighting in Junior A and professional hockey leagues; (5) establish objective tests to diagnose concussion at point of care (POC); and (6) mandate baseline testing to improve concussion diagnosis for all age groups. Conclusions Expedient implementation of the Summit III prioritized action items is necessary to reduce the risk, severity and consequences of concussion in the sport of ice hockey

Learning to learn: improving attainment, closing the gap at Key Stage 3

In 2010, a comprehensive secondary school in the south of England implemented a whole-school approach to ‘learning to learn’ (L2L). Drawing on a range of evidence-based practices, a team of teachers worked collaboratively to design and deliver a taught L2L curriculum to all students throughout Key Stage 3. In total, the first cohort of students (n = 118) received more than 400 taught lessons throughout years 7–9. The impact of L2L on student attainment at Sea View was evaluated over those 3 years, using the pre-L2L cohort as a matched control group (n = 148). By the end of year 9, a significantly higher proportion of L2L students were either hitting or exceeding their target grades, compared with the control group. There was also a significant closing of the attainment gap between students eligible for the pupil premium and their peers (2%, vs. 25% in the control group). Key features of the L2L approach at Sea View are considered in terms of similarities and differences with other L2L approaches. Conclusions are drawn that the success of this approach lies in the combination of multiple effective practices. Recommendations for further research and development of the field are proposed