Identifying Trends of Dysautonomia Signs and Symptoms Associated with Protracted Concussion Recovery during the Buffalo Concussion Treadmill Test: A Retrospective Study
Lauren Ziaks
A * , Jenna Tucker B , Thomas Koc A Intermountain Rehabilitation Services,
B School of Physical Therapy,
Abstract
To identify trends of provoked dysautonomia signs and symptoms during the Buffalo Concussion Treadmill Test (BCTT).
This is a retrospective cohort study of 101 patient charts post-concussion who were screened for suspected dysautonomia.
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.
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.
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: Concussion, dysautonomia, exercise intolerance, evaluation.
References
Callaway C., Kosofsky B. E. (2019) Autonomic dysfunction following mild traumatic brain injury. Current Opinion in Neurology 32(6), 802-807.
| Crossref | Google Scholar |
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.
| Crossref | 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
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.
| Crossref | Google Scholar |
Cleveland Clinic Medical Professionals (2020). Dysautonomia. Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/diseases/6004-dysautonomia
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.
| Crossref | Google Scholar |
DeMeulenaere S. (2007) Pulse oximetry: Uses and limitations. The Journal for Nurse Practitioners 3(5), 312-317.
| Crossref | Google Scholar |
Esterov D., Greenwald B. D. (2017) Autonomic dysfunction after mild traumatic brain injury. Brain Sciences 7(8), 100.
| Crossref | Google Scholar |
Franco F. A. (2007) Cerebral autoregulation and syncope. Progress in Cardiovascular Diseases 50(1), 49-80.
| Crossref | 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.
| Crossref | Google Scholar |
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.
| Crossref | Google Scholar |
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.
| Crossref | Google Scholar |
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.
| Crossref | Google Scholar |
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.
| Crossref | Google Scholar |
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.
| Crossref | 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.
| Crossref | Google Scholar |
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.
| Crossref | Google Scholar |
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.
| Crossref | Google Scholar |
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.
| Crossref | 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.
| Crossref | Google Scholar |
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
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.
| Crossref | Google Scholar |
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.
| Crossref | 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.
| Crossref | 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
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.
| Crossref | Google Scholar |
Thompson J. W. G., Hagedorn D. (2012) Multimodal analysis: New approaches to the concussion conundrum. Journal of Clinical Sport Psychology 6(1), 22-46.
| Crossref | 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.
| Crossref | Google Scholar |
