Return to Learning and Neuroimaging Quiz

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Questions and Answers

What is the main goal during the Return to Learning Stage 1?

Achieve full academic participation

Complete all missed assignments

Engage in daily activities that provoke symptoms

Gradual return to typical daily activities with mild symptoms (correct)

Which of the following steps is NOT involved in the return-to-sport strategy?

Structured Staged Progression

Readiness Confirmation

Immediate full participation in sports (correct)

Initial Symptom-Limited Activity

At what stage of Return to Learning are students expected to return on a part-time basis?

Stage 1

Stage 3 (correct)

Stage 4

Stage 2

Which aspect is crucial in the iterative process of ongoing monitoring and feedback?

Regularly checking in on student progress Signup and view all the answers

Which is an example of a cognitive activity introduced in Stage 2 of Return to Learning?

Homework and reading outside the classroom Signup and view all the answers

How long must students remain symptom-free before advancing to the next stage in return-to-sport?

24 hours Signup and view all the answers

What is the primary goal of Stage 4 in the Return to Learning process?

Engage in academic activities without symptoms Signup and view all the answers

What does the BOLD signal specifically measure in the brain?

Differences between oxygenated and deoxygenated blood Signup and view all the answers

How is global functional connectivity (Gconn) primarily quantified between different brain regions?

Through analyzing the correlation of BOLD signals Signup and view all the answers

What is a potential consequence of altered functional connectivity patterns following a concussion?

Change in brain function and organization Signup and view all the answers

Which of the following is not listed as a disadvantage of advanced neuroimaging techniques?

Limited range of biochemical analysis Signup and view all the answers

What is the primary focus of magnetic resonance spectroscopy (MRS) in neuroimaging?

Providing information about the biochemical composition of tissues Signup and view all the answers

What is the primary purpose of introducing cognitive load in Stage 3 of the protocol?

To assess cognitive processing alongside physical performance. Signup and view all the answers

In Stage 4, which specific measurement is used to determine cardiovascular performance?

Achieving 80-90% of age-predicted HRmax. Signup and view all the answers

Which of the following correctly defines a biomarker?

A measurable characteristic reflecting normal or abnormal biological processes. Signup and view all the answers

What aspect is primarily monitored during the testing stages outlined in the protocol?

Heart rate, symptoms, and performance metrics. Signup and view all the answers

What is the aim of the exercise involving box jump-overs with a 180-degree twist?

To challenge agility and decision-making under physical stress. Signup and view all the answers

Why is it important to ensure athletes do not return to sport too soon?

To reduce the risk of re-injury or delayed recovery. Signup and view all the answers

What type of data do biomarkers provide compared to subjective reports?

Objective data that reflects physiological states. Signup and view all the answers

The Controlled Oral Word Association Test (COWAT) used in Stage 3 is primarily for assessing which of the following?

Cognitive performance during physical activities. Signup and view all the answers

Which combination is included in the exercise regimen of Stage 3?

Squats, alternating reverse lunges, and hip hinges with cognitive tasks. Signup and view all the answers

What is the primary role of Matrix Metalloproteinase-9 (MMP-9) in the context of the blood-brain barrier (BBB)?

Facilitates the breakdown of the BBB. Signup and view all the answers

Which of the following is a consequence of increased BBB permeability?

Infiltration of immune cells and plasma proteins. Signup and view all the answers

What type of immune cells primarily infiltrate the brain following BBB breakdown?

Neutrophils and macrophages. Signup and view all the answers

What is a potential long-term consequence of chronic neuroinflammation?

Neuronal injury and synaptic dysfunction. Signup and view all the answers

Which biomarker is associated with neurodegeneration and is released following axonal damage?

Tau Protein. Signup and view all the answers

Which marker is indicative of neuronal injury, often correlating with the severity of brain injury?

Neurofilament Heavy (NFH). Signup and view all the answers

What role do cytokines play following BBB disruption?

They propagate the inflammatory response. Signup and view all the answers

What is indicated by elevated levels of Myelin Basic Protein (MBP)?

Myelin sheath damage. Signup and view all the answers

Which of the following statements is true regarding neuroinflammation?

It is an initial protective response. Signup and view all the answers

Which biomarker provides insights into the extent of axonal damage?

Spectrin Breakdown Products (SBDPs). Signup and view all the answers

Which biomarkers show significant increases during the medical clearance phase when comparing SRC to healthy controls?

T-tau and PRDX-6 Signup and view all the answers

What is one of the key FDA-approved biomarkers utilized for evaluating concussions?

GFAP Signup and view all the answers

Which statement accurately describes the impact of physical exertion on biomarker levels?

It influences biomarker levels, complicating accurate diagnoses. Signup and view all the answers

What is a noted disadvantage of using peripheral blood biomarkers for concussion diagnosis?

They cannot provide definitive diagnoses for concussions. Signup and view all the answers

Which imaging technique has limited utility for diagnosing concussions absent structural damage?

CT scans Signup and view all the answers

In the context of sex differences in inflammatory biomarkers, how many biomarkers showed significant differences?

4 out of 10 Signup and view all the answers

What was observed regarding GFAP levels after exercise in a study on healthy males?

GFAP levels significantly decreased. Signup and view all the answers

Which of the following factors is NOT mentioned as affecting biomarker levels?

Genetic predisposition Signup and view all the answers

Which of the following is a requirement for effective diagnosis of concussions using neuroimaging techniques?

Presence of macrostructural changes. Signup and view all the answers

What is a common misconception regarding blood tests for concussions?

They are used for diagnosing concussions. Signup and view all the answers

Study Notes

Module 7 - Return to Sport, Neuropsychological Tests, Exertion Tests

Describes the impact of concussions on return to school
Concussions affect up to 64% of students academically, impacting information processing, focus, and completing assignments
A systematic review shows no impact on school attendance, academic performance, and the perception of academic difficulties
Approximately 31% of students report a drop in their grades post-concussion, impacting their future opportunities
Cognitive symptoms include impaired attention, memory deficits, and executive functioning difficulties (planning, organizing, decision-making)
Emotional challenges such as frustration, anxiety, and social withdrawal can impact the reintegration into the school environment
Missing school can isolate students from their peers and can exacerbate loneliness and anxiety
Strategies to help students reintegrate into academic settings include minimizing symptoms, emphasizing a cautious approach to increasing academic demands, and customizing accommodations for each individual

Return to School

Strategies (Stage 1 - At Home) include physical and cognitive rest, basic board games, crafts, simple phone calls, limiting computer/TV/texting/video games, and no school work/sports.
Activities to increase cognitive function (Stage 2 - At Home) may include light cognitive activities (limited to 30 minutes), reading, TV, drawing, limited peer contact, and gradually adding homework at home
Activities to gradually increase in school (Stage 3- At School) involve part-time school with maximum accommodations, schoolwork as per a return to school plan, limiting PE, PA, homework, testing, and gradually increasing school time
Activities to gradually increase in school (Stage 4- At School) are similar to Stage 3, increase school time with moderate accommodations, homework up to 30 minutes daily, classroom testing adaptations.
Activities to reach full-time school return (Stage 5 - At School) include full days at school with minimal accommodations, reducing accommodations, increasing homework to 60 minutes daily, limiting routine testing to one test day
Full return to school (Stage 6 - At School) includes full days at school with no learning accommodations, attend all classes, full extracurricular involvement, and full testing

Module 8 - Biomarkers, Micro RNA, Neuroimaging, Technology

Describes a biomarker as a measurable characteristic to indicate normal or abnormal biological processes, pathogenic processes, or responses to interventions.
Biomarkers can be biological molecules found in blood, other body fluids, or tissues.
Examples of biomarkers in concussion research include MRI, blood pressure, heart variability, spinal drain, and blood draw.

Micro-RNA (miRNA)

miRNAs are small non-coding RNAs that easily cross the blood-brain barrier for measurement
miRNAs control mRNA expression and proteins post-transcriptionally through mRNA degradation and ribosomal inhibition
Methods to analyze miRNAs include RT-PCR, microarray, and RNA sequencing

Key Considerations for Biomarker Research in Concussion

Sex differences in concussion recovery and severity are present
Variation is present amongst individuals and must be considered when applying biomarkers, including age, sex, genetic disposition, and base level cognitive function

Module 10 - Clinical Recovery, Prolonged and Decreased Recovery

The hierarchy of scientific evidence is discussed, including systematic reviews, randomized controlled trials, cohort studies, case-control studies, animal trials, in vitro studies, case reports, and expert opinions.

Module 11 - Additional Treatment Strategies, Risky Calculation, Risks of Injury following Concussion

Common symptoms of concussion include visual disturbances (blurred vision, double vision), light sensitivity, headache, dizziness, screen intolerance, balance problems, ringing in the ears, nausea, and vertigo; cervical spine issues like neck pain or reduced range of motion, emotional/mood disturbances, sleep disturbances, and headaches/migraines
Treatment strategies for these symptom clusters are mentioned, such as smooth pursuits, saccades, convergence, gaze stabilization, peripheral vision exercises, vestibular/balance exercises, physical therapy and referral to an optometrist or audiologist.
Discussions of specific strategies to address cervical spine issues, emotional/mood disturbances, sleep disturbances, and headaches/migraines.

12.1 Describe the Progression of CTE Understanding from the 1900s to Current

Martland introduced "punch drunk" in 1928 to describe repeated head traumas in boxers and documented speech abnormalities, gait issues, and tremors
1934: Parker described "traumatic encephalopathy of pugilists"
1937: Millspaugh detailed "dementia pugilistica"
Other key findings across the progression of CTE research are discussed
1973: Coursellis neurofibrillary tangles (NFTs)
1990: Roberts found diffuse beta-amyloid plaques and NFTs
2005: Omalu's case report of Mike Webster was significant, linking repetitive head injuries directly to CTE in an NFL player
2009-2013: McKee's work established microscopic pathological features
Findings relating to the study of Mike Webster are discussed

12.2 Understand Why Dr. Omalu's Findings Were Significant in Professional Sports

Omalu's 2005 paper was the first to neuropathologically link chronic traumatic encephalopathy to football, highlighting the risks of repetitive head trauma
Findings from the case report of Mike Webster revealed a macroscopically normal-looking brain despite damage, and identified diffuse amyloid plaques, sparse neurofibrillary tangles, and tau-positive threads.
This led to increased awareness of long-term neurological risks in football, and challenged concussion management practices adopted by the NFL
Research into player safety was prompted and some changes came into concussion protocols within the NFL

12.3 Describe the Different Neuropathological Features of CTE

Clinical features of CTE include memory disturbances, irritability, aggressive or violent behaviours, confusion, speech abnormalities, cognitive decline, gait abnormalities, headache, and parkinsonism.
Gross pathological features of CTE include atrophy of the cerebral hemispheres, thalamus, mammillary bodies, and brainstem; enlarged lateral and third ventricles; cavum septum pellucidum.
Microscopic pathological features include tau-positive neurofibrillary tangles (NFTs) and astrocytic tangles, as well as dot-like and spindle or thread-like neuropil tau positive threads

12.4 Understand the Progression of Dr. McKee's CTE Findings

McKee’s 2009 review included 47 cases of CTE, detailing clinical, gross, and microscopic features

12.5 Differentiate Between Concussions and Repetitive Head Impacts and Current Repetitive Head Impact Findings

Concussions stem from a singular traumatic event, resulting in immediate symptoms and medical diagnosis
Repetitive head impacts (RHIs) are characterized by repeated head impacts
Individuals may not see immediate symptoms from a single RHI but may develop long-term issues like CTE

12.6 Define Traumatic Encephalopathy Syndrome (TES) and the Most Recent TES Criteria (2021):

TES criteria include a history of multiple head impacts, no other neurological disorders, clinical symptoms, and features present for 12 months with a change in baseline functioning.
Specific criteria for 2014 and 2021 TES are mentioned.

12.7 Understand the Flaws of the TES 2014 Criteria

2014 criteria lacked specificity and were vague in their definitions, and challenging in distinguishing TES from other neurological disorders.
Clearer diagnostic guidelines, based on evolving scientific understanding, are needed.

12.8 Describe the Different Modifiable Risk Factors for Cognitive Impairment

Identified risk factors for cognitive impairment due to concussion.
Factors include things like inadequate sleep, inadequate sleep duration, obesity, hypertension, cardiovascular disease, diabetes, chronic pain, poor mental health, higher levels of pre-existing anxiety and depression, smoking, inactivity

12.9 Understand the Associations of Medical Conditions and TES

Study evaluated associations with medical conditions, demographic and health factors, and exposure to repeated head traumas by analyzing cognitive impairment and neurobehavioral dysregulation in 1741 former NFL players
Findings were noted on the links to conditions such as ADHD, diabetes, erectile dysfunction, headaches, and sleep apnea all strongly linked to cognitive impairment and neurobehavioral dysregulation.

12.10 Understand the Concussion in Sport Group (Consensus Statement) Stance and Findings

The 2023 Consensus Statement focused on case-control and cohort designs, excluding studies with smaller numbers of subjects, and majority of Dr. McKee and BU's studies weren't included. The Consensus Statement's findings highlighted no increased risk of depression, suicidality, cognitive impairment.
Findings noted some associations between professional football and soccer participation in developing neurological diseases (like dementia and ALS)

12.11 Be Familiar with More Detailed Symptom Clusters

Symptom clusters include things like visual disturbances (blurred vision, light sensitivity, double vision), vestibular/balance issues, cervical spine issues, emotional/mood disturbances, sleep disorders, and headaches/migraines

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Description

Test your knowledge on the Return to Learning stages and the role of neuroimaging in understanding post-concussion recovery. This quiz covers key concepts from the Return to Learning framework and details about brain connectivity and neuroimaging techniques. Assess your understanding of important steps and goals related to cognitive recovery after injury.