Reviewer: Yuka Kobayashi, DO (Medical College of Wisconsin)
Description: Concussion remains a public health concern. This second edition covers the new and evolving technology and methodology in diagnosing and treating concussions since the original book was published in 2014. The authors advocate for multiple modalities of evaluation and management of sport-related concussions for best outcomes and urge the continued research and use of advanced imaging (fMRI, rs-fMRI, DMN, DTI, MRS), EEG, genetics, and physiological markers. The book starts by addressing the consequences of mismanaging patients who experience concussions and dispels the 10 common myths surrounding concussions. Then, each chapter discusses the recent advancements in concussion management, authored by leaders of that research field. Finally, it expands on the growing literature on pediatric concussions and the long-term consequences of repetitive head trauma.
Purpose: The authors collected empirical evidence from advanced neuroimaging, biomechanical, motor control, physiology, and pediatric studies to outline the shortcomings of the current understanding of sport-related concussions. They argue that there is growing evidence to prove that concussions are not always injuries that athletes recover quickly and spontaneously from, but rather an injury that may linger for months to years. To better understand the pathophysiology, this book outlines the empirical evidence from fMRI, rs-fMRI, DMN, DTI, MRS, and EEG studies that support this claim. The authors acknowledge that these expensive and often clinically unavailable tools still need to be validated in order for implementation in practice. By compiling the evidence in this book, the authors hope to bridge the gap between basic science and clinical science to better care for patients who suffer concussions. Concussion research has grown significantly over the last couple of decades, and it is critical that the most up-to-date information is distributed for practitioners and researchers who focus on patients with concussion. This book comprehensively reviews the most recent literature on concussion management, evidenced by its extensive reference list. The book is also authored by the leaders of their respective fields in research and clinical management of concussions. As such, the book does an excellent job of outlining the empirical evidence in a minimally biased way.
Audience: This book is for anyone who cares for athletes with concussions. Also, administrators and policymakers of sport organizations would benefit from an in-depth understanding of concussion as it is a public health concern. There is a basic understanding of concussion needed for readers prior to delving into this book. I believe this book is appropriate for students, residents, fellows, neurologists, PM&R and family medicine practitioners, pediatricians, sports medicine practitioners, neuropsychologists, psychologists, and more. If a practitioner is involved in the care of patients suffering from concussions, it is crucial that all members of the team be aware of and on the same page about concussion diagnosis, management, and prognosis. Caring for this patient population often takes a team, even more so than other diagnoses in medicine, so this book is appropriate for all members of the team. Dr. Slobounov and Dr. Sebastianelli are both recognized experts in research and the clinical management of concussions with hundreds of publications between them. Dr. Slobounov has NIH, DOD, NCAA, and NFL funded research and directs the Virtual Reality/Traumatic Brain Injury Lab at Penn State. Dr. Sebastianelli, the sports medicine medical director and the director of athletic medicine at Penn State, also focuses his research on traumatic brain injuries.
Features: The editors of this book recruited authors to discuss their specific areas of expertise and research. Each chapter focuses on diagnostic and/or therapeutic technology. Part I discusses the evaluation of concussion and the new assessment tools such as EEG and virtual reality. Although these evaluation tools are not widely used in clinical practice yet, the authors suggest that there is feasibility to expand the use of such advancements in the future. The section also discusses neuropsychological testing in the non-traditional sense, when baseline testing is not available, which is a topic of interest for many who treat patients with concussion. Part II examines the biomechanics and motor control mechanisms of concussion, which focuses on postural control assessment, helmet analysis and characteristics, gait analysis, and gait surface evaluation. Part III discusses the growing body of evidence that neuroimaging and biomarkers play in the diagnosis and prognosis of concussions. Given the possible long-term implications of concussions sustained in the pediatric population, part IV focuses on this specific patient population. The section starts by suggesting a model for post-concussive syndrome and the relationship between injury and non-injury factors that play a role in the prediction of prolonged recovery from concussion. Finally, part V discusses clinical management and rehabilitation of concussions, including relative rest, exercise, psychoeducation, CBT, mindfulness-based stress reduction, return to play protocols, return to learn protocols, and more. The evidence in the book is presented by experts in their respective fields, making it thorough and comprehensive. The book also outlines the further direction of each research and clinical field, which makes it engaging and thought provoking. The research presented by those who authored the publication makes it difficult to be completely objective and without bias. However, it does make it more comprehensive. The updated research on vestibulo-ocular, physical, and ophthalmic therapies are missing from the end of the text where management of concussions is discussed.
Assessment: This is a useful book for those caring for patients suffering concussions. It presents empirical evidence of the most recent literature in this field. There are few books that review the most recent literature on such a breadth of topics. Books such as Neuropsychology of Sports-Related Concussions, Arnett (American Psychological Association, 2019) touches on the assessment, diagnosis, and management of concussions from the lens of neuropsychology and the American Psychological Association; however, it does not delve into the details of new empirical evidence compared to the book under review. The details of the research discussed in this book are more comprehensive, and although practitioners may feel the practical application from this book to be lacking, that is not the goal of this book. The body of research in sport-related concussions is quickly growing and this book does warrant a second edition, as an updated reference of empirical evidence on concussion for sports medicine has been lacking for the last few years.
