This prospective, observational study addresses the overarching hypothesis that brain dysfunction and structural injury are present at one month post- sports concussion (SC) in asymptomatic high school athletes who have been cleared by a licensed health provider (LHP) for return to play (RTP). We hypothesize that a biomarker measured from serum on the day of recruitment is prognostic of recovery by one month post-SC. High school athletes will be recruited within three days post-SC (n=24) from consecutive referrals to Memorial Hermann Sports Medicine Clinic in Houston. A comparison group of 24 high school athletes with orthopedic injury (OI) will also be recruited. Weekly assessment via telephone of post-concussion symptoms will identify athletes who are asymptomatic by one month and cleared for RTP. At one month post-injury both groups will return to clinic for neurobehavioral assessment, magnetic resonance imaging (MRI), diffusion tensor imaging (DTI) and resting state functional magnetic resonance imaging to measure functional connectivity (FC) of brain regions. Data analysis will test between-group differences in integrity of white matter tracts (DTI) and FC of brain regions. Biomarker levels will be analyzed in relation to brain imaging and neurobehavioral recovery at one month in SC group.

Public Health Relevance

This project, Imaging and Biomarkers in Adolescents Cleared for Return to Play After Concussion, examines alteration of functional connectivity of neural networks implicated in cognition and the structural connectivity of the brain regions comprising these networks. We also propose to measure biomarker levels in blood within three days after sports concussion to evaluate their relation to concurrent, post-concussion symptom severity and cognition and to brain imaging findings acquired one month post-injury when clinical recovery has typically occurred. This project challenges the underpinnings of conventional, clinical approaches to sports concussion by studying brain function and microstructure to understand residual cerebral dysfunction and vulnerability despite clinical recovery.

National Institute of Health (NIH)
National Institute of Neurological Disorders and Stroke (NINDS)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (ZRG1-BDCN-N (58))
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Hicks, Ramona R
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Baylor College of Medicine
Physical Medicine & Rehab
Schools of Medicine
United States
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Levin, Harvey (2016) France establishes guidelines for treating neurobehavioral disorders following traumatic brain injury. Ann Phys Rehabil Med 59:74-7
Newsome, Mary R; Li, Xiaoqi; Lin, Xiaodi et al. (2016) Functional Connectivity Is Altered in Concussed Adolescent Athletes Despite Medical Clearance to Return to Play: A Preliminary Report. Front Neurol 7:116
Wilde, Elisabeth A; Hunter, Jill V; Li, Xiaoqi et al. (2016) Chronic Effects of Boxing: Diffusion Tensor Imaging and Cognitive Findings. J Neurotrauma 33:672-80
Cristofori, Irene; Levin, Harvey S (2015) Traumatic brain injury and cognition. Handb Clin Neurol 128:579-611