A Multifaceted Assessment of Post-Concussion Adolescent Startle Response and Injury
Jessie Oldham, PhD
BACKGROUND: Concussions are classified as a major health disorder, and approximately 20% of adolescents in the United States report a history of at least one diagnosed concussion in their lifetime; further, premature return to sport can result in additional injuries, including cerebral edema, catastrophic neurological injury, and musculoskeletal injury. A suppressed startle response could be responsible for lingering impairments that follow concussion and could be an identifiable risk factor for subsequent injury.
GAP: The acoustic startle reflex has not been investigated following concussion in humans, and this will be the first study to examine the acoustic startle reflex as a potential indicator of post-concussion physiological dysfunction.
HYPOTHESIS: We hypothesize that currently concussed adolescents will have a suppressed startle response compared to healthy controls, and adolescents with a history of concussion, particularly multiple concussions, will have a suppressed startle response compared to both healthy controls and currently concussed individuals. Additionally, we hypothesize that adolescents with a suppressed startle response will demonstrate greater odds of sustaining a subsequent injury in the year following concussion.
METHODS: This protocol is a prospective, longitudinal study that will assess the startle reflex and its association with dynamic postural control and vestibular-ocular function over time. We will enroll 90 adolescents (30 healthy controls, 30 with a concussion history, and 30 currently concussed) who report to Boston Children’s Hospital.
IMPACT: The startle reflex could serve as an objective biomarker of brainstem dysfunction following concussion and assist clinicians in making decisions about return to sport, as well as be a predictive tool to help clinicians identify adolescents who are more likely to sustain a subsequent injury following concussion.