There is a growing empirical evidence that virtual reality (VR) is valuable for education, training, entertaining and medical rehabilitation due to its capacity to represent real-life events and ...situations. However, the neural mechanisms underlying behavioral confounds in VR environments are still poorly understood. In two experiments, we examined the effect of fully immersive 3D stereoscopic presentations and less immersive 2D VR environments on brain functions and behavioral outcomes. In Experiment 1 we examined behavioral and neural underpinnings of spatial navigation tasks using electroencephalography (EEG). In Experiment 2, we examined EEG correlates of postural stability and balance. Our major findings showed that fully immersive 3D VR induced a higher subjective sense of presence along with enhanced success rate of spatial navigation compared to 2D. In Experiment 1 power of frontal midline EEG (FM-theta) was significantly higher during the encoding phase of route presentation in the 3D VR. In Experiment 2, the 3D VR resulted in greater postural instability and modulation of EEG patterns as a function of 3D versus 2D environments. The findings support the inference that the fully immersive 3D enriched-environment requires allocation of more brain and sensory resources for cognitive/motor control during both tasks than 2D presentations. This is further evidence that 3D VR tasks using EEG may be a promising approach for performance enhancement and potential applications in clinical/rehabilitation settings.
•3D VR induces a high sense of presence during virtual navigation task.•3D VR induces destabilizing effect on postural stability.•Differential modulation of cortical activity during 3D versus 2D VR environment
The aim of this study was to systematically review clinical studies examining biofluid biomarkers of brain injury for concussion in athletes. Data sources included PubMed, MEDLINE, and the Cochrane ...Database from 1966 to October 2013. Studies were included if they recruited athletes participating in organized sports who experienced concussion or head injury during a sports-related activity and had brain injury biomarkers measured. Acceptable research designs included experimental, observational, and case-control studies. Review articles, opinion papers, and editorials were excluded. After title and abstract screening of potential articles, full texts were independently reviewed to identify articles that met inclusion criteria. A composite evidentiary table was then constructed and documented the study title, design, population, methods, sample size, outcome measures, and results. The search identified 52 publications, of which 13 were selected and critically reviewed. All of the included studies were prospective and were published either in or after the year 2000. Sports included boxing (six studies), soccer (five studies), running/jogging (two studies), hockey (one study), basketball (one study), cycling (one study), and swimming (one study). The majority of studies (92%) had fewer than 100 patients. Three studies (23%) evaluated biomarkers in cerebrospinal fluid (CSF), one in both serum and CSF, and 10 (77%) in serum exclusively. There were 11 different biomarkers assessed, including S100β, glial fibrillary acidic protein, neuron-specific enolase, tau, neurofilament light protein, amyloid beta, brain-derived neurotrophic factor, creatine kinase and heart-type fatty acid binding protein, prolactin, cortisol, and albumin. A handful of biomarkers showed a correlation with number of hits to the head (soccer), acceleration/deceleration forces (jumps, collisions, and falls), postconcussive symptoms, trauma to the body versus the head, and dynamics of different sports. Although there are no validated biomarkers for concussion as yet, there is potential for biomarkers to provide diagnostic, prognostic, and monitoring information postinjury. They could also be combined with neuroimaging to assess injury evolution and recovery.
•Virtual reality (VR) and EEG were used to investigate the effect of visual perturbation on standing posture.•Whole body postural responses were not different between predictable and unpredictable ...conditions.•Unpredictable timing and direction of perturbation.
There is evidence from EEG studies that unexpected perturbations to standing posture induce a differential modulation of cortical activity compared to self-initiated and/or predictable conditions. However, the neural correlates of whole body postural response to visually induced perturbations on standing posture have not been examined. Here we employ a novel experimental paradigm via combined virtual reality (VR) and EEG measures to examine the effects of visually induced perturbations on the dynamics of postural responses. Twelve Penn State student-athletes without prior history of neurologic disorders and/or orthopaedic injuries participated in this study. There were no differences in response/reaction time measures between both spatially and temporally unpredictable and fully predictable conditions (p>.05). However, significantly stronger modulation of frontal–central EEG theta activity was present prior to onset of unpredictable postural perturbations (p<.05). It is postulated that enhanced EEG theta in unpredictable conditions reflects increased effort to recruit additional brain resources to meet the demands of the postural tasks.
There are a number of symptoms, both neurological and behavioral, associated with a single episode of r mild traumatic brain injury (mTBI). Neuropsychological testing and conventional neuroimaging ...techniques are not sufficiently sensitive to detect these changes, which adds to the complexity and difficulty in relating symptoms from mTBI to their underlying structural or functional deficits. With the inability of traditional brain imaging techniques to properly assess the severity of brain damage induced by mTBI, there is hope that more advanced neuroimaging applications will be more sensitive, as well as specific, in accurately assessing mTBI. In this study, we used resting state functional magnetic resonance imaging to evaluate the default mode network (DMN) in the subacute phase of mTBI. Fourteen concussed student-athletes who were asymptomatic based upon clinical symptoms resolution and clearance for aerobic exercise by medical professionals were scanned using resting state functional magnetic resonance imaging. Nine additional asymptomatic yet not medically cleared athletes were recruited to investigate the effect of a single episode of mTBI versus multiple mTBIs on the resting state DMN. In concussed individuals the resting state DMN showed a reduced number of connections and strength of connections in the posterior cingulate and lateral parietal cortices. An increased number of connections and strength of connections was seen in the medial prefrontal cortex. Connections between the left dorso-lateral prefrontal cortex and left lateral parietal cortex showed a significant reduction in magnitude as the number of concussions increased. Regression analysis also indicated an overall loss of connectivity as the number of mTBI episodes increased. Our findings indicate that alterations in the brain resting state default mode network in the subacute phase of injury may be of use clinically in assessing the severity of mTBI and offering some insight into the pathophysiology of the disorder.
► We investigated the default mode network in subacute mTBI. ► Resting-state fMRI showed that there are disruptions in the DMN in subacute mTBI. ► Overall mTBI caused reduced strength and number of connections in the DMN. ► The number of mTBI appears to have an impact on the connectivity of the DMN.
Highlights ► Prolonged administration of neuropsychological testing induces increased self-reported and performance-related fatigue. ► Modulation of EEG activity during neuropsychological testing is ...an index of fatigue rather than a training effect. ► Fatigue effect should be taken into consideration during administration of a neuropsychological test battery in clinical populations.
Falls among the older population can severely restrict their functional mobility and even cause death. Therefore, it is crucial to understand the mechanisms and conditions that cause falls, for which ...it is important to develop a predictive model of falls. One critical quantity for postural instability detection and prediction is the instantaneous stability of quiet upright stance based on motion data. However, well-established measures in the field of motor control that quantify overall postural stability using center-of-pressure (COP) or center-of-mass (COM) fluctuations are inadequate predictors of instantaneous stability. For this reason, 2D COP/COM virtual-time-to-contact (VTC) is investigated to detect the postural stability deficits of healthy older people compared to young adults. VTC predicts the temporal safety margin to the functional stability boundary ( = limits of the region of feasible COP or COM displacement) and, therefore, provides an index of the risk of losing postural stability. The spatial directions with increased instability were also determined using quantities of VTC that have not previously been considered. Further, Lempel-Ziv-Complexity (LZC), a measure suitable for on-line monitoring of stability/instability, was applied to explore the temporal structure or complexity of VTC and the predictability of future postural instability based on previous behavior. These features were examined as a function of age, vision and different load weighting on the legs. The primary findings showed that for old adults the stability boundary was contracted and VTC reduced. Furthermore, the complexity decreased with aging and the direction with highest postural instability also changed in aging compared to the young adults. The findings reveal the sensitivity of the time dependent properties of 2D VTC to the detection of postural instability in aging, availability of visual information and postural stance and potential applicability as a predictive model of postural instability during upright stance.
The cumulative effect of repetitive subconcussive collisions on the structural and functional integrity of the brain remains largely unknown. Athletes in collision sports, like football, experience a ...large number of impacts across a single season of play. The majority of these impacts, however, are generally overlooked, and their long-term consequences remain poorly understood. This study sought to examine the effects of repetitive collisions across a single competitive season in NCAA Football Bowl Subdivision athletes using advanced neuroimaging approaches. Players were evaluated before and after the season using multiple MRI sequences, including T
-weighted imaging, diffusion tensor imaging (DTI), arterial spin labeling (ASL), resting-state functional MRI (rs-fMRI), and susceptibility weighted imaging (SWI). While no significant differences were found between pre- and post-season for DTI metrics or cortical volumes, seed-based analysis of rs-fMRI revealed significant (
< 0.05) changes in functional connections to right isthmus of the cingulate cortex (ICC), left ICC, and left hippocampus. ASL data revealed significant (
< 0.05) increases in global cerebral blood flow (CBF), with a specific regional increase in right postcentral gyrus. SWI data revealed that 44% of the players exhibited outlier rates (
< 0.05) of regional decreases in SWI signal. Of key interest, athletes in whom changes in rs-fMRI, CBF and SWI were observed were more likely to have experienced high G impacts on a daily basis. These findings are indicative of potential pathophysiological changes in brain integrity arising from only a single season of participation in the NCAA Football Bowl Subdivision, even in the absence of clinical symptoms or a diagnosis of concussion. Whether these changes reflect compensatory adaptation to cumulative head impacts or more lasting alteration of brain integrity remains to be further explored.
Abstract
Objective
Repetitive head impacts (RHIs) experienced during sports are gaining attention due to potential long-term neurological dysfunction, absent of a diagnosed concussion. One area ...susceptible to dysfunction is vision. The goal of this study was to evaluate changes in visual quality of life (VQOL) and functional vision scores from pre- to post-season among collision and non-collision athletes.
Methods
The Visual Functioning Questionnaire-25 and Neuro-Ophthalmic Supplement (NOS), as well as functional vision testing (Mobile Universal Lexicon Evaluation System – MULES) were completed pre- and post-season by three groups: collision athletes, non-collision athletes, and minimally active controls (MACs).
Results
There were 42 participants, with 41 (21 male, 20 female) completing both testing sessions, with a mean (standard deviation SD) age of 21 (2.46) years (collision group, n = 14; non-collision group, n = 13, MACs, n = 14). Baseline analyses revealed no significant differences between groups for VQOL or MULES scores. However, those with a family history of psychiatric disorder scored significantly worse on NOS. Post-season/follow-up testing revealed no significant differences between groups for VQOL scores. Non-collision athletes significantly improved on the MULES test by 2.46 ± 3.60 (SD) s (35.0 95% confidence interval, 0.29–4.63; p = .03). Change score results from pre- to post-season were not significant.
Conclusion
Although the groups were not significantly different from one another, non-collision athletes significantly improved MULES scores, whereas collision athletes performed the worst, suggesting exposure to RHIs may impact functional vision. Thus, further evaluation of RHIs and their impact on vision is warranted.
Contact sports participation has been shown to have both beneficial and detrimental effects on health, however little is known about the metabolic sequelae of these effects. We aimed to identify ...metabolite alterations across a collegiate American football season. Serum was collected from 23 male collegiate football athletes before the athletic season (Pre) and after the last game (Post). Samples underwent nontargeted metabolomic profiling and 1131 metabolites were included for univariate, pathway enrichment, and multivariate analyses. Significant metabolites were assessed against head acceleration events (HAEs). 200 metabolites changed from Pre to Post (P < 0.05 and Q < 0.05); 160 had known identity and mapped to one of 57 pre-defined biological pathways. There was significant enrichment of metabolites belonging to five pathways (P < 0.05): xanthine, fatty acid (acyl choline), medium chain fatty acid, primary bile acid, and glycolysis, gluconeogenesis, and pyruvate metabolism. A set of 12 metabolites was sufficient to discriminate Pre from Post status, and changes in 64 of the 200 metabolites were also associated with HAEs (P < 0.05). In summary, the identified metabolites, and candidate pathways, argue there are metabolic consequences of both physical training and head impacts with football participation. These findings additionally identify a potential set of objective biomarkers of repetitive head injury.
This prospective cohort study examined the relationship between a panel of four serum proteomic biomarkers (glial fibrillary acidic protein GFAP, ubiquitin C-terminal hydrolase-L1 UCH-L1, total Tau, ...and neurofilament light chain polypeptide NF-L) in 52 players from two different cohorts of male collegiate student football athletes from two different competitive seasons of Division I National Collegiate Athletic Association Football Bowl Subdivision. This study evaluated changes in biomarker concentrations (as indicators of brain injury) over the course of the playing season (pre- and post-season) and also assessed biomarker concentrations by player position using two different published classification systems. Player positions were divided into: 1) speed (quarterbacks, running backs, halfbacks, fullbacks, wide receivers, tight ends, defensive backs, safety, and linebackers) versus non-speed (offensive and defensive linemen), and 2) “Profile 1” (low frequency/high strain magnitudes positions including quarterbacks, wide receivers, and defensive backs), “Profile 2” (mid-range impact frequency and strain positions including linebackers, running backs, and tight ends), and “Profile 3” (high frequency/low strains positions including defensive and offensive linemen). There were significant increases in GFAP 39.3 to 45.6 pg/mL and NF-L 3.5 to 5.4 pg/mL over the course of the season (
p
< 0.001) despite only five players being diagnosed with concussion. UCH-L1 decreased significantly, and Tau was not significantly different. In both the pre- and post-season blood samples Tau and NF-L concentrations were significantly higher in speed versus non-speed positions. Concentrations of GFAP, Tau, and NF-L increased incrementally from “Profile 3,” to “Profile 2” to “Profile 1” in the post-season. UCH-L1 did not. GFAP increased (by Profiles 3, 2, 1) from 42.4 to 49.6 to 78.2, respectively (
p
= 0.051). Tau increased from 0.37 to 0.61 to 0.67, respectively (
p
= 0.024). NF-L increased from 3.5 to 4.9 to 8.2, respectively (
p
< 0.001). Although GFAP and Tau showed similar patterns of elevations by profile in the pre-season samples they were not statistically significant. Only NF-L showed significant differences between profiles 2.7 to 3.1 to 4.2 in the pre-season (
p
= 0.042). GFAP, Tau, and NF-L concentrations were significantly associated with different playing positions with the highest concentrations in speed and “Profile 1” positions and the lowest concentrations were in non-speed and “Profile 3” positions. Blood-based biomarkers (GFAP, Tau, NF-L) provide an additional layer of injury quantification that could contribute to a better understanding of the risks of playing different positions.
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