Integrative Data Analysis to Identify Persistent Post-Concussion Deficits and Subsequent Musculoskeletal Injury Risk

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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.