Publications by authors named "Robert Davis Moore"

11 Publications

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Impact of Concussion History on Heart Rate Variability during Bouts of Acute Stress.

J Athl Train 2021 Sep 20. Epub 2021 Sep 20.

Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.

Context: Following a sports-related concussion, many athletes experience persisting neurophysiological alterations. These alterations may be absent at rest but emerge during moments of physiological stress. Unnoticed and untreated neurophysiological dysfunction may negatively impact long-term neurological health in adolescent athletes as they are at a critical point in development.

Objective: To assess cardio-autonomic functioning in athletes with and without a history of concussion by quantifying measures of heart rate variability (HRV) during times of physical and mental exertion.

Design: Case-control study.

Setting: Research laboratory Patients or Other Participants: Thirty-four male midget-AAA hockey players were separated into those with (n = 16, age = 16.1 ± 1 years, BMI = 23.3 ± 1.8) and those without (n = 18, age = 16.0 ±1 years, BMI = 23.6 ± 2.5) a history of concussion.

Intervention(s): All athletes completed a series of HRV recording sessions: 1) at rest; 2) while completing a cognitive task at rest; and 3) while completing a cognitive task after a bout of submaximal aerobic exercise.

Main Outcome Measure(s): Time-domain measures of HRV; mean NN interval (NN), standard deviation of NN interval (SDNN), and root mean square of successive differences (RMSSD) were quantified for each assessment.

Results: Analyses revealed no demographic differences between groups. No between-group differences in HRV at rest, were observed. However, during completion of the cognitive task at rest and following aerobic exercise, athletes with a history of concussion demonstrated significantly higher SDNN (63.2 ± 4.1 vs. 78.1 ± 4.3; 65.2 ± 3.8 vs 71.2 ± 4.3, p = 0.046) and RMSSD (59.0 ± 5.6 vs. 75.8 ± 6.0; 59.0 ± 5.2 vs. 74.0 ± 5.5, p = 0.035).

Conclusion: The results suggest concussive injuries may result in long-term cardio-autonomic dysfunction. Furthermore, these deficits may not be present at rest but may be triggered by physiological stress.
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http://dx.doi.org/10.4085/1062-6050-0314.21DOI Listing
September 2021

Post-exercise cognitive testing to assess persisting alterations in athletes with a history of concussion.

Brain Inj 2021 07 5;35(8):978-985. Epub 2021 Jul 5.

School of Kinesiology and Exercise Science, Université De Montréal, Montreal, QC, Canada.

: To determine whether a physical exercise protocol could reveal persistent cognitive alterations in university athletes with a history of concussion (HOC). Thirty-four HOC and 34 controls participated in this study.: Cross-sectional.: The exercise protocol consisted of a 20-min bout on a stationary bike at 80% of the theoretical maximal heart rate. Before and after the exercise, participants performed a computerized switch task designed specifically to recruit executive functions. Group × Condition (pre- and post-exercise) repeated measures of ANCOVAs for accuracy, reaction time, and inverse efficiency score on the switch task were conducted. Chi-square tests were run to determine if the proportion of HOC and controls who underperformed (at least 2SD lower than the control group's average score) at rest and post-exercise were similar. Whilst no interaction or main effects were found with ANCOVAs, significantly more HOC athletes (21%) underperformed following exercise than at rest (3%) on the switch task, = .02. The current results indicate that an acute bout of exercise can reveal persistent alterations that are not present at rest in the protracted phase of concussion. They also highlight the importance of considering inter-individual differences in recovery trajectories.
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http://dx.doi.org/10.1080/02699052.2021.1944668DOI Listing
July 2021

The Influence of Family History of Neurodegenerative Disease on Adolescent Concussion Outcomes.

J Clin Med 2021 Feb 2;10(3). Epub 2021 Feb 2.

Concussion Health and Neuroscience Lab, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.

Evidence suggests that factors associated with a family history of neurodegenerative disease (fhNDD) may influence outcomes following a concussion. However, the relevance of these findings in adolescent populations has not been fully explored. Therefore, the present study sought to evaluate the relationship between fhNDD and neurological outcomes following an adolescent concussion. Data from a local pediatric concussion clinic were used to compare adolescents with ( = 22) and without ( = 44) an fhNDD. Clinical symptom burden, emotional health, cardio-autonomic function, and cognitive performance were assessed at initial (~2 weeks) and follow-up (~5 weeks) post-injury evaluations. Cardio-autonomic function was assessed at rest and during isometric handgrip contraction (IHGC). Results indicated no significant group differences in emotional health or cognitive performance. Across evaluations, those with an fhNDD exhibited greater somatic symptom severity, alterations in HRV at rest, and early blunted cardio-autonomic reactivity during IHGC compared to those without an fhNDD. These findings suggest that positive fhNDD is negatively associated with clinical symptomology and cardio-autonomic functioning following an adolescent concussion. Further, these findings encourage clinicians to utilize a comprehensive neurological evaluation to monitor concussion recovery. Future studies should look into exploring the role of specific neurodegenerative processes and conditions on concussion outcomes in adolescents.
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http://dx.doi.org/10.3390/jcm10030528DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7867167PMC
February 2021

Predictive Value of Subacute Heart Rate Variability for Determining Outcome Following Adolescent Concussion.

J Clin Med 2021 Jan 5;10(1). Epub 2021 Jan 5.

Concussion Health and Neuroscience Lab, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.

Objective assessments of concussion recovery are crucial for facilitating effective clinical management. However, predictive tools for determining adolescent concussion outcomes are currently limited. Research suggests that heart rate variability (HRV) represents an indirect and objective marker of central and peripheral nervous system integration. Therefore, it may effectively identify underlying deficits and reliably predict the symptomology following concussion. Thus, the present study sought to evaluate the relationship between HRV and adolescent concussion outcomes. Furthermore, we sought to examine its predictive value for assessing outcomes. Fifty-five concussed adolescents (12-17 years old) recruited from a local sports medicine clinic were assessed during the initial subacute evaluation (within 15 days postinjury) and instructed to follow up for a post-acute evaluation. Self-reported clinical and depressive symptoms, neurobehavioral function, and cognitive performance were collected at each timepoint. Short-term HRV metrics via photoplethysmography were obtained under resting conditions and physiological stress. Regression analyses demonstrated significant associations between HRV metrics, clinical symptoms, neurobehavioral function, and cognitive performance at the subacute evaluation. Importantly, the analyses illustrated that subacute HRV metrics significantly predicted diminished post-acute neurobehavioral function and cognitive performance. These findings indicate that subacute HRV metrics may serve as a viable predictive biomarker for identifying underlying neurological dysfunction following concussion and predict late cognitive outcomes.
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http://dx.doi.org/10.3390/jcm10010161DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7796512PMC
January 2021

Psychometric properties of a color-shape version of the switch task.

Appl Neuropsychol Adult 2020 Dec 9:1-10. Epub 2020 Dec 9.

School of Kinesiology and Exercise Science, Université de Montréal, Montreal, Canada.

The current study aims to examine the psychometric properties of a color-shape version of the switch task. In Study 1, 128 participants completed a battery of standardized measures of executive functions (EFs) as well as the switch task to determine the construct validity of three traditionally computed costs (global, switch, and mixing) and primary variables (accuracy [ACC], reaction time [RT], and inverse efficiency score [IES] of the heterogeneous condition). In Study 2, 48 participants completed the task twice, seven days apart, to evaluate its short-term test-retest reliability. Results do not support the construct validity and the test-retest reliability of switch and mixing costs. The overall higher psychometric properties of the global costs (RT and IES), and primary variables (Hetero RT and IES) suggest that they may be useful measures for clinicians to assess EFs. The latter variables show evidence of convergent validity with standardized measures of EFs and good test-rest reliability (ICC ≥ .68).
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http://dx.doi.org/10.1080/23279095.2020.1842410DOI Listing
December 2020

Practice effect associated with the serial administration of the switch task and its implications in the assessment of sports-related concussion.

J Clin Exp Neuropsychol 2020 11 11;42(9):965-973. Epub 2020 Oct 11.

School of Kinesiology and Exercise Science, Université de Montréal , Montreal, Quebec, Canada.

In the context of return to play assessment following a sports concussion, athletes may have to complete a cognitive task several times within days. The current longitudinal study aimed to examine the practice effect associated with the serial administration of the switch task. We hypothesized that the practice effect would be the greatest between the first and second assessments and that a plateau would be obtained by the third assessment. Forty healthy university students completed the switch task four times at an interval of 48-hour, with half of them doing version A on all visits (AA group), while the others alternated between A and B every other assessment (AB group). For response accuracy, performance generally improved from V1 to V2, and from V2 to V3 ( ≤.001), irrespective of group. For reaction time, a significant interaction of Visit × Group was observed. Specifically, AA group performance improved from V1 to V2, and from V2 to V3, while the AB group only improved from V2 to V3 ( ≤.01). Performance improved over the first three assessments and stabilized with no statistically significant change between the third and fourth testing sessions. Although the use of an alternative version has helped reduce the practice effect, it did not help in eliminating it. The current results highlight the need for further examination of the practice effect and its implication in clinical decision-making. Clinicians working in the sports concussion field must take the practice effect into account when they use the switch task for serial testing.
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http://dx.doi.org/10.1080/13803395.2020.1828836DOI Listing
November 2020

Clinically Historical and Prospective Associations Between Learning Disorders and Concussion in Young Adult Athletes.

Am J Lifestyle Med 2020 Mar-Apr;14(2):187-193. Epub 2018 Sep 14.

École de psychoéducation, Université de Montréal, Canada (LSP).

. Athletes with specific learning disorder (LD) tend to score lower on neuropsychological tests and are at increased risk of personal injury than their counterparts without such disorders. Using a retrospective historical and prospective design, we examined whether adult athletes with LD, the most prevalent of neurodevelopmental disorders, experience greater chances of past and future concussions than their counterparts without LD. We expected to find that young athletes with LD would show greater risk of past (historical) and future (prospective) cerebral concussions. . Participants (95 men and 53 women aged 18 to 25 years) were recruited from university sports teams and followed during an entire season. Of these, 38 participants had a history of LD and 101 had a history of at least 1 concussion (72 males, 29 females) at the preseason baseline. One-third experienced a new concussion. Data analytic procedures include inferential cross-tabulations. . Athletes with LD were twice more likely to have a concussion history at baseline and to have a history of multiple concussions than athletes without LD; 95% CI = [0.86, 4.92] and [0.77, 3.40], respectively. Athletes with LD were twice more likely to incur a new concussion than those without LD; 95% CI = [0.86, 4.92]. . Adult athletes with LD experience greater chances of previous and future concussions compared with counterparts without LD. Preventive practices regarding individuals with neurodevelopmental disorders may not only prevent the biopsychosocial consequences of brain trauma for the individual, but also represent a cost-effective public health measure.
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http://dx.doi.org/10.1177/1559827618793350DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7092401PMC
September 2018

Long-term cognitive outcomes in male and female athletes following sport-related concussions.

Int J Psychophysiol 2018 10 20;132(Pt A):3-8. Epub 2018 Mar 20.

Department of Kinesiology, Université de Montréal, 2100 Édouard-Montpetit, Montreal, QC H3T 1J4, Canada; Centre de recherche en neuropsychologie et cognition, Université de Montréal, 90 rue Vincent d'Indy, Montreal, QC H2V 2S9, Canada. Electronic address:

Despite concussion being a serious public health concern and the increasing participation of female athletes in sport, the comparative long-term outcomes of male and female athletes are poorly understood, potentially limiting the scientific understanding and clinical management of these injuries. We examined whether sex influences the long-term cognitive outcomes in athletes with a history of concussion (HOC; 6+ months from injury). Accordingly, 196 asymptomatic student-athletes participated in the study (98 with a HOC; 98 matched controls). The sample included both male (n = 98) and female athletes (n = 98). Participants completed the Cogstate brief battery, to which we added a 2-Back condition to increase cognitive load. As predicted, the results revealed sex differences on the N-back Task, a measure of executive functions, with female athletes having a HOC responding significantly more slowly than their male counterparts on the 2-Back condition (p = 0.02). Moreover, irrespective of sex, athletes with a HOC were slower and less accurate relative to controls on the N-back Task (p = 0.01). Analyses failed to reveal any significant sex or group difference on tasks that measure lower-level cognition (ps > 0.05). The current results reaffirm the presence of subtle, yet long-term alterations in aspects of executive functions following a sport-related concussion. More importantly, our results highlight that female athletes exhibit alterations of greater magnitude than their male counterparts. Therefore, the sex difference observed in the days or weeks following a concussion may persist well into the chronic phase of injury.
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http://dx.doi.org/10.1016/j.ijpsycho.2018.03.011DOI Listing
October 2018

Neurophysiological correlates of persistent psycho-affective alterations in athletes with a history of concussion.

Brain Imaging Behav 2016 12;10(4):1108-1116

University of Montreal, Montreal, QC, Canada.

Understanding the neuropathological underpinnings of sport-related concussion are critical for diagnosis, prognosis, and remediation. Although electro-encephalographic (EEG) methods have proven invaluable for understanding psycho-affective pathologies in various clinical conditions, they have not been used to understand the psycho-affective outcomes of concussive injuries. Accordingly, we evaluated the relation of electroencephalographic (EEG) power in collegiate athletes to psycho-affective measures. We predicted that athletes with a history of concussion would exhibit alterations in frontal EEG asymmetries indicative of increased depression, anxiety and more general mood disturbance. During this cross-sectional study, resting EEG and measures of mood and affect, including the Beck Depression Inventory-II (BDI-II) and Profile of Mood States (POMS) were collected in 81 young-adult male athletes (52 concussion history; 29 controls). All athletes with a history of concussion (9+ months from injury) reported to be symptom free, and all participants were actively taking part in their sport at the time of testing. Compared to control athletes, the athletes with a history of concussion exhibited alterations in frontal-alpha and frontal-beta asymmetry (p's < .05). Correlational analyses revealed that alterations in frontal-alpha asymmetry were related to self-reported depression and anxiety, and alterations in beta-asymmetry were related to self-reported anger/aggression, but these relations were only significant for athletes with a history of concussion. The current study suggests that athletes with a history of concussion who made a complete return to play and reported to be asymptomatic on a commonly used symptom checklist may still exhibit neural activity associated with increased levels of depression, anxiety and anger/hostility. The current results reinforce the clinical necessity for long-term evaluations of athletes irrespective of apparent symptom resolution, and suggest that EEG may serve as a sensitive tool to identify and track concussion-related alterations in psycho-affective health before they manifest as clinical disorders.
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http://dx.doi.org/10.1007/s11682-015-9473-6DOI Listing
December 2016

Persisting Effects of Concussion on Heart Rate Variability during Physical Exertion.

J Neurotrauma 2016 05 8;33(9):811-7. Epub 2015 Oct 8.

1 Department of Kinesiology, Université de Montréal , Montreal, Quebec, Canada .

The purpose of this study was to evaluate cardiac autonomic modulation in university athletes during the post-acute to late phase (mean, 95 days ±63) of injury at rest and during physical exertion. We also sought to evaluate the effect of time since injury and number of injuries on heart rate variability (HRV). We hypothesized that physical exertion would reveal persisting modifications in HRV following a concussion. We included, in a cross-sectional design, athletes who sustained a concussion and matched controls. Concussions were identified by a medical doctor using established criteria. Twelve male concussed and 12 control athletes took part in the study. Control participants were teammates who were chosen to match the concussed athletes with regard to their height, weight, education, and age. The beat-to-beat electrocardiogram intervals of the participants were measured at rest and during physical exertion (isometric hand grip contraction; IHGC), which was sustained for 3 minutes at 30% of the participants' maximum. Linear and nonlinear parameters of HRV were calculated. The ratio between low and high frequency (LF/HF) bands was calculated to assess the sympathovagal balance. During the IHGC, but not at rest, concussed athletes presented significantly lower power in HF bands, leading to a significantly higher LF/HF ratio (p ≤ 0.05). Thus, asymptomatic athletes still may exhibit modifications in cardiac autonomic modulation weeks to months following injury. These modifications may only become apparent during physical exertion. Monitoring HRV may aid diagnosis and provide insight about safe return to play.
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http://dx.doi.org/10.1089/neu.2015.3989DOI Listing
May 2016

Aerobic fitness and intra-individual variability of neurocognition in preadolescent children.

Brain Cogn 2013 Jun 16;82(1):43-57. Epub 2013 Mar 16.

Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Illinois, United States.

This study examined behavioral and neuroelectric intra-individual variability (IIV) in preadolescent children during a task requiring variable amounts of cognitive control. The current study further examined whether IIV was moderated by aerobic fitness level. Participants performed a modified flanker task, comprised of congruent and incongruent arrays, within compatible and incompatible stimulus-response conditions. Results revealed that congruent, relative to incongruent, conditions were associated with less IIV of RT. Further, less IIV of RT, P3 amplitude, and P3 latency was observed for the compatible relative to the incompatible condition. Higher fitness was associated with shorter and less variable RT only for the incompatible condition, with no fitness-related differences observed for P3 variability. The findings suggest that conditions requiring greater cognitive control are associated with increased IIV, and that higher fitness may be associated with greater integrity of cognitive control systems during development.
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http://dx.doi.org/10.1016/j.bandc.2013.02.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632076PMC
June 2013
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