Browsing by Author "Debert, Chantel T."
Now showing 1 - 6 of 6
Results Per Page
Sort Options
- ItemOpen AccessImproving symptom burden in adults with persistent post-concussive symptoms: a randomized aerobic exercise trial protocol(2020-02-05) Mercier, Leah J.; Fung, Tak S.; Harris, Ashley D.; Dukelow, Sean P.; Debert, Chantel T.Abstract Background Persistent post-concussive symptoms (PPCS) affect up to 30% of individuals following mild traumatic brain injury. PPCS frequently includes exercise intolerance. Sub-symptom threshold aerobic exercise has been proposed as a treatment option for symptom burden and exercise intolerance in this population. The primary aim of this study is to evaluate whether a progressive, sub-symptom threshold aerobic exercise program can alleviate symptom burden in adults with PPCS. Methods Fifty-six adults (18–65) with PPCS (>3mos-5 yrs) will be randomized into two groups: an immediate start 12-week aerobic exercise protocol (AEP) or delayed start 6-week placebo-like stretching protocol (SP), followed by AEP. Aerobic or stretching activities will be completed 5x/week for 30 mins during the intervention. Online daily activity logs will be submitted. Exercise prescriptions for the AEP will be 70–80% of heart rate at the point of symptom exacerbation achieved on a treadmill test with heart rate monitoring. Exercise prescription will be updated every 3-weeks with a repeat treadmill test. The Rivermead Post-concussion Symptom Questionnaire will be the primary outcome measure at 6 and 12-weeks of intervention. Secondary outcomes include assessments of specific symptoms (headache, quality of life, mood, anxiety, fatigue, dizziness, sleep parameters, daytime sleepiness) in addition to blood biomarkers and magnetic resonance imaging and spectroscopy data for quantification of brain metabolites including γ-aminobutyric acid (GABA), glutathione, glutamate and N-acetyl aspartate (NAA) all measured at 6 and 12-weeks of intervention. Discussion This trial will evaluate the use of aerobic exercise as an intervention for adults with PPCS, thus expanding our knowledge of this treatment option previously studied predominantly for adolescent sport-related concussion. Trial registration ClinicalTrials.gov - NCT03895450 (registered 2019-Feb-11).
- ItemOpen AccessMeasuring Cerebral Oxygenation in Healthy and Concussed Brain Using Frequency Domain Near-Infrared Spectroscopy (fdNIRS)(2018-06-14) Dleikan, Diane; Dunn, Jeff F.; Yeates, Keith Owen; Debert, Chantel T.Concussion or mild traumatic brain injury (mTBI) is a major public health concern that affects millions of people annually. The current metrics used to assess and diagnose concussion are largely subjective. There is a need for an objective neuroimaging tool to directly measure brain physiology and provide insight into recovery. Such a tool would supplement current subjective metrics used to monitor and index severity of injury. There is also a need to better understand the pathophysiology of concussion. Near-infrared spectroscopy (NIRS) is a non-invasive optical imaging tool used to measure aspects of microvascular hemoglobin oxygenation. In this study, we apply NIRS to quantify cerebral oxygenation (StO2), which has been used as an indicator of oxygen delivery to assess injury severity and tissue damage. We measured StO2 in a large cohort population with varying ages, and compared this to two post-concussive groups. In the first, a small varsity cohort, cerebral oxygenation was reduced in athletes who reported increased symptom severity. In the second, a pediatric sports-related concussion (SRC) cohort, cerebral oxygenation was increased when compared to age and gender matched controls. We also found that exercise is a potential confounding variable to consider when assessing concussion on the sideline, as we reported increases in StO2 in most varsity football players after practice. We report intriguing but not conclusive evidence that concussion can cause acute reduction in oxygenation, which may indicate changes in brain physiology immediately after injury. Overall, this thesis demonstrated that prefrontal cortex StO2, measured by NIRS, has the potential for monitoring brain physiology during concussion recovery in a clinical and sport setting.
- ItemOpen AccessReduced Functional Connectivity in Adults with Persistent Post-Concussion Symptoms: A Functional Near-Infrared Spectroscopy Study(Mary Ann Liebert, Inc., 2018-06-01) Hocke, Lia Maria; Duszynski, Chris C.; Debert, Chantel T.; Dleikan, Diane; Dunn, Jeff F.Concussion, or mild traumatic brain injury (mTBI), accounts for ∼80% of all TBIs across North America. The majority of mTBI patients recover within days to weeks; however, 14-36% of the time, acute mTBI symptoms persist for months or even years and develop into persistent post-concussion symptoms (PPCS). There is a need to find biomarkers in patients with PPCS, to improve prognostic ability and to provide insight into the pathophysiology underlying chronic symptoms. Recent research has pointed toward impaired network integrity and cortical communication as a biomarker. In this study we investigated functional near-infrared spectroscopy (fNIRS) as a technique to assess cortical communication deficits in adults with PPCS. Specifically, we aimed to identify cortical communication patterns in prefrontal and motor areas during rest and task, in adult patients with persistent symptoms. We found that (1) the PPCS group showed reduced connectivity compared with healthy controls, (2) increased symptom severity correlated with reduced coherence, and (3) connectivity differences were best distinguishable during task and in particular during the working memory task (n-back task) in the right and left dorsolateral prefrontal cortex (DLPFC). These data show that reduced brain communication may be associated with the pathophysiology of mTBI and that fNIRS, with a relatively simple acquisition paradigm, may provide a useful biomarker of this injury.
- ItemOpen AccessRegulation of cerebral blood flow and ventilation by oxygen and carbon dioxide in women(2003) Debert, Chantel T.; Poulin, Marc J.
- ItemOpen AccessTreatment of Persistent Headache Attributed to Mild Traumatic Injury to the Head in Patients with Persistent Post Concussion Symptoms using Repetitive Transcranial Magnetic Stimulation(2019-05-07) Stilling, Joan M.; Monchi, Oury; Debert, Chantel T.; Amoozegar, Farnaz; Dukelow, Sean P.Persistent post-traumatic headache (PTH) following a mild traumatic brain injury (mTBI) is one of the most prominent and highly-reported persistent post-concussion symptoms (PPCS). Non-pharmacologic treatment alternatives, including non-invasive neurostimulation technologies, have been proposed for use. After a systematic review investigating transcranial magnetic and direct current stimulation (TMS/tDCS) for management of headache, we designed a double-blind, sham-controlled, randomized trial investigating repetitive TMS (rTMS) for treatment of persistent PTH in patients with PPCS. Our primary outcome was a change in headache frequency and severity at one-month post-treatment. Twenty participants underwent rTMS therapy to the left dorsolateral prefrontal cortex (DLPFC). Headache diaries and clinical questionnaires assessing function, cognition, and mood were completed. Headache severity demonstrated a significant time effect, while headache frequency demonstrated a reduction across all time points for both the real and sham groups, based on descriptive analysis. Secondary outcomes demonstrated improvements in function, reduced PPCS, and depression in the real-treatment group, with no serious adverse effects. A phase II study is warranted.
- ItemOpen AccessUltrasound-guided platelet-rich plasma injections for post-traumatic greater occipital neuralgia: study protocol for a pilot randomized controlled trial(2021-06-22) Stone, Jacqueline E.; Fung, Tak S.; Machan, Matthew; Campbell, Christina; Shan, Rodney L. P.; Debert, Chantel T.Abstract Background Post-traumatic headaches (PTH) are a common sequelae of traumatic brain injury (TBI) and greatly impact patient function and quality of life. Post-traumatic greater occipital neuralgia (GON) is a type of post-traumatic headache. Conventional treatment includes steroid/anesthetic injections which typically alleviate pain but have a short duration of effect. Platelet-rich plasma (PRP) is an emerging biological treatment for numerous degenerative disorders, including peripheral nerve disorders. The primary aim of this pilot study is to evaluate whether a randomized control trial of PRP for the treatment of GON in patients with post-traumatic headaches is feasible in regard to recruitment, adherence, retention, and adherence and adverse events. Exploratory aims include improvement in pain, function, and quality of life in patients with post-traumatic GON receiving PRP compared to steroid/anesthetic and normal saline injections. Methods Thirty adults (over 18 years of age) with post-traumatic GON will be randomized into one of three groups: (1) autologous PRP injection, (2) steroid/anesthetic injection (standard care), or (3) placebo injection with normal saline. Injections will be performed to the greater occipital nerve under ultrasound guidance by a trained physician. Daily headache intensity and frequency data will be collected pre-injection and for the duration of the study period. Feasibility will be defined as greater than 30% recruitment, 70% completion of intervention, 70% retention, and less than 2 minor adverse events. Exploratory outcomes will be explored using the Headache Impact Test-6 (HIT-6, a valid and reliable 6-item questionnaire for assessment of the impact of headaches across different diagnostic groups of headaches) and the quality of life in following brain injury questionnaire (QOILIBRI). Discussion This pilot study will be the first to evaluate the feasibility of PRP as a potential treatment of GON in patients with post-traumatic headache. Trial registration ClinicalTrials.gov - NCT04051203 (registered August 9, 2019).