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Neurocognitive and Psychosocial Effects of Repeated Concussions in Children and Adolescents Shina Halavi

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Neurocognitive and Psychosocial Effects of Repeated Concussions in Children and Adolescents Shina Halavi Loma Linda University TheScholarsRepository@LLU: Digital Archive of Research, Scholarship & Creative Works Loma Linda University Electronic Theses, Dissertations & Projects 6-2018 Neurocognitive and Psychosocial Effects of Repeated Concussions in Children and Adolescents Shina Halavi Follow this and additional works at: http://scholarsrepository.llu.edu/etd Part of the Clinical Psychology Commons, and the Medicine and Health Sciences Commons Recommended Citation Halavi, Shina, "Neurocognitive and Psychosocial Effects of Repeated Concussions in Children and Adolescents" (2018). Loma Linda University Electronic Theses, Dissertations & Projects. 502. http://scholarsrepository.llu.edu/etd/502 This Dissertation is brought to you for free and open access by TheScholarsRepository@LLU: Digital Archive of Research, Scholarship & Creative Works. It has been accepted for inclusion in Loma Linda University Electronic Theses, Dissertations & Projects by an authorized administrator of TheScholarsRepository@LLU: Digital Archive of Research, Scholarship & Creative Works. For more information, please contact [email protected]. LOMA LINDA UNIVERSITY School of Behavioral Health in conjunction with the Faculty of Graduate Studies ____________________ Neurocognitive and Psychosocial Effects of Repeated Concussions in Children and Adolescents by Shina Halavi ____________________ A Dissertation submitted in partial satisfaction of the requirements for the degree Doctor of Philosophy in Clinical Psychology ____________________ June 2018 © 2018 Shina Halavi All Rights Reserved Each person whose signature appears below certifies that this dissertation in his/her opinion is adequate, in scope and quality, as a dissertation for the degree Doctor of Philosophy. , Chairperson Richard E. Hartman, Professor of Psychology , Co-Chairperson Anita H. Hamilton, Assistant Professor, Keck School of Medicine, University of Southern California Brian J. Distelberg, Associate Professor, Counseling and Family Sciences Grace J. Lee, Assistant Professor of Psychology iii ACKNOWLEDGEMENTS I would like to express my deepest gratitude to my dissertation committee, family, and friends for their unwavering support throughout this journey. I would like to thank Dr. Hartman for his continuous guidance and motivation and Dr. Hamilton for the access to this data and the opportunity to conduct this research. Drs. Hartman, Hamilton, Lee, and Distelberg had immense knowledge on the subject and provided excellent resources and guidance to ensure my success. iv CONTENT Approval Page .................................................................................................................... iii Acknowledgements ............................................................................................................ iv List of Figures .................................................................................................................. viii List of Tables ..................................................................................................................... xi List of Abbreviations ........................................................................................................ xii Abstract ..............................................................................................................................xv Chapter 1. Literature Review.....................................................................................................1 Demographics ....................................................................................................1 Definition ...........................................................................................................2 Neuroanatomy ....................................................................................................2 Normal Brain Development ...............................................................................3 Biomechanics of Concussion .............................................................................7 Neurometabolic Cascade of Concussion ...........................................................8 Concussion in the Younger Versus Older Athlete .............................................9 Severity of Concussion ....................................................................................10 Signs and Symptoms ........................................................................................11 Evaluation and Diagnosis ................................................................................12 Sideline Evaluation ....................................................................................13 Neuroimaging ............................................................................................14 Neuropsychology .......................................................................................14 Management .....................................................................................................16 Return to Play ..................................................................................................17 Recovery ..........................................................................................................19 Repeated Concussions .....................................................................................20 Complications ............................................................................................20 Chronic Traumatic Encephalopathy ....................................................21 Second Impact Syndrome ....................................................................23 Post-Concussion Syndrome ................................................................24 2. Dissertation Aims ...................................................................................................27 v Aim 1 ...............................................................................................................27 Aim1a/Hypothesis 1a ................................................................................27 Single Concussion ................................................................................28 Repeated Concussion ...........................................................................32 Aim1b/Hypothesis 1b ................................................................................35 Aim1c/Hypothesis 1c .................................................................................39 Aim1d ........................................................................................................40 Hypothesis 1d1 .....................................................................................40 Hypothesis 1d2 .....................................................................................41 Hypothesis 1d3 .....................................................................................43 Hypothesis 1d4 .....................................................................................46 Aim 2 ...............................................................................................................47 Aim2a/Hypothesis 2a .................................................................................47 Aim2b/Hypothesis 2b ................................................................................49 Aim2c/Hypothesis 2c .................................................................................51 Aim2d ........................................................................................................52 Hypothesis 2d1 .....................................................................................52 Hypothesis 2d2 .....................................................................................54 Hypothesis 2d3 .....................................................................................55 Hypothesis 2d4 .....................................................................................56 Aim 3 ...............................................................................................................56 3. Specific Aims .........................................................................................................59 Aim 1 ...............................................................................................................59 Aim 2 ...............................................................................................................61 Aim 3 ...............................................................................................................62 4. Significance............................................................................................................63 5. Innovation ..............................................................................................................66 6. Method ...................................................................................................................69 Patients .............................................................................................................69 Measures ..........................................................................................................71 Behavioral Assessment System for Children, 2nd Edition (BASC-2) ........71 vi Modified Balance Error Scoring System (Modified BESS) ......................72 California Verbal Learning Test ...............................................................72 California Verbal Learning Test, Children’s Version (CVLT-C) .......73 California Verbal Learning Test, Second Edition (CVLT-II) .............73
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