PROJECT SUMMARY/ABSTRACT
There are an estimated 1.6 – 3.8 million concussion which occur annually in the United States and they have
potentially serious complications including second impact syndrome related fatalities, recurrent concussions or
other subsequent injuries, and later life neuropathologies. Current findings have successfully focused on the
acute diagnosis of concussions; however, sensitive and specific determination of concussion remains to be
elucidated and therefore athletes may be returning to participation despite persistent neurophysiological
deficits. Furthermore, potentially due to these persistent deficits, recent evidence is suggesting an elevated
risk (¿1.5 – 3.0x) of subsequent musculoskeletal injury in the year following concussion. Therefore, the first
aim of this study is to quantify post-concussion neurophysiological deficits utilizing the NINDS common data
elements (CDEs) and an instrumented single and dual task gait protocol. The second aim of the study will
apply a sophisticated high dimensional integrative and censored sufficient dimension reduction (Hi-CSDR)
modeling to assess the effectiveness of common data elements in developing a composite risk score for
subsequent musculoskeletal injury. This model will be developed from the extensive existing concussion
database which includes both the common data elements and portable gait analysis results. The Hi-CSDR
modeling has the advantage of operating in the context of longitudinal analysis with a diverse set of grouped
variables, censored and missing data While the elevated risk of post-concussion musculoskeletal injury is well
established in the literature, the underlying mechanism has not identified, however preliminary results suggest
persistent impairments in postural control may be involved. To achieve these aims, we will recruit ~100
concussed student-athletes who will be assessed on the NINDS CDEs at baseline, through clinical recovery,
and monthly up to six months post-concussion to determine neurophysiological recovery. To address a major
limitation in the literature, we will recruit approximately an even number of male and female participants. These
participants will be added to the existing database (N>400) for the developed of the composite risk score
through the Hi-CSDR model to identify musculoskeletal injury risk. All participants will be tracked through
electronic medical records to identify musculoskeletal injuries in the year following the concussion while
controlling for prior concussion history and prior musculoskeletal injury. These findings, if objectively
documented, would identify the role of post-concussion neurophysiological impairments and elucidate a
potential underlying mechanism of subsequent musculoskeletal injury.
