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Abstract There are differences within the literature regarding the upper frequency cut‐off point of the dynamic cerebral autoregulation (CA) high‐pass filter. The projection pursuit regression approach has demonstrated that the upper frequency limit is ∼0.07 Hz, whereas another approach [transfer function analysis (TFA) phase approaching zero] indicated a theoretical upper frequency limit for the high‐pass filter of 0.24 Hz. We investigated how these limits accurately represent the CA upper frequency limit, in addition to extending earlier findings with respect to biological sexes and across the cardiac cycle. Sixteen participants (nine females and seven males) performed repeated squat–stand manoeuvres at frequencies of 0.05, 0.10, 0.15, 0.20 and 0.25 Hz, with insonation of the middle and posterior cerebral arteries. Linear regression modelling with adjustment for sex and order of squat completion was used to compared TFA gain and phase with 0.25 Hz (above the theoretical limit of CA). The upper frequency limit of CA with TFA gain was within the range of 0.05–0.10 Hz, whereas TFA phase was within the range of 0.20–0.25 Hz, and consistent between vessels, between sexes and across the cardiac cycle. Females displayed greater middle cerebral artery gain compared with males (all P 0.072). Although sex‐specific differences were present for specific TFA metrics at a given frequency, the upper frequency limit of autoregulation was similar between cerebral conduit vessels, cardiac cycle phase and biological sex. Future work is warranted to determine whether an upper frequency limit exists with respect to hysteresis analyses.

Background: This study explored a novel multimodal neuroimaging approach to assess neurovascular coupling (NVC) in humans using electroencephalography (EEG), functional near-infrared spectroscopy (fNIRS), and transcranial Doppler ultrasound (TCD). Methods: Fifteen participants (nine females; age 19–32) completed concurrent EEG-fNIRS-TCD imaging during motor (finger tapping) and visual (“Where's Waldo?”) tasks, with synchronized monitoring of blood pressure, capnography, and heart rate. fNIRS assessed microvascular oxygenation within the frontal, motor, parietal, and occipital cortices, while the middle and posterior cerebral arteries (MCA/PCA) were insonated using TCD. A 16-channel EEG set-up was placed according to the 10–20 system. Wilcoxon signed-rank tests were used to compare physiological responses between the active and resting phases of the tasks, while cross-correlations with zero legs compared cerebral and systemic hemodynamic responses across both tasks. Results: Time-frequency analysis demonstrated a reduction in alpha and low beta band power in electrodes C3/C4 during finger tapping (p < 0.045) and all electrodes during the Waldo task (all p < 0.001). During Waldo, cross-correlation analysis demonstrated the change in oxygenated hemoglobin and cerebral blood velocity had a moderate-to-strong negative correlation with systemic physiological influences, highlighting the measured change resulted from neuronal input. Deoxygenated hemoglobin displayed the greatest negative cross-correlation with the MCA/PCA within the motor cortices and visual during the motor and visual tasks, respectively (range:0.54, -0.82). Conclusions: This investigation demonstrated the feasibility of the proposed EEG-fNIRS-TCD response to comprehensively assess the NVC response within human, specifically quantifying the real-time temporal synchrony between neuronal activation (EEG), microvascular oxygenation changes (fNIRS), and conduit artery velocity alterations (TCD).

IntroductionIntimate partner violence (IPV) is a global health crisis with 30% of women over the age of 15 experiencing at least one event in their lifetime. Brain injury (BI) due to head impacts and/or strangulation is a common but understudied part of this experience. Previous research has shown BI from other injury mechanisms can disrupt neurovascular coupling (NVC). To gain further insight into whether similar changes occur in this population, we assessed NVC responses in women with a history of IPV-BI.MethodsNVC responses were measured for the middle and posterior cerebral arteries (MCA, PCA) using transcranial Doppler ultrasound while participants performed a complex visual search task. The lifetime history of previous exposure to IPV-BI was captured using the Brain Injury Severity Assessment (BISA) along with measures of post-traumatic stress disorder (PTSD), anxiety, depression, substance use, and demographic information. Initial analyses of NVC metrics were completed comparing participants who scored low vs. high on the BISA or did or did not experience non-fatal strangulation followed by a stepwise multiple regression to examine the impact of PTSD, anxiety, and depression on the relationship between the NVC metrics and IPV-BI.ResultsBaseline and peak cerebral blood velocity were higher and the percentage increase was lower in the PCA in the low compared to the high BISA group whereas no differences between the groups were apparent in the MCA. In addition, those participants who had been strangled had a lower initial slope and area under the curve in the PCA than those who had not experienced strangulation. Finally, the stepwise multiple regression demonstrated the percentage increase in the PCA was significantly related to the BISA score and both depression and anxiety significantly contributed to different components of the NVC response.ConclusionsThis preliminary study demonstrated that a lifetime history of IPV-BI leads to subtle but significant disruptions to NVC responses which are modulated by comorbid depression and anxiety. Future studies should examine cerebrovascular function at the acute and subacute stages after IPV episodes to shed additional light on this experience and its outcomes.

Introduction: Concussion is known to cause transient autonomic and cerebrovascular dysregulation that generally recovers; however, few studies have focused on individuals with an extensive concussion history. Method: The case was a 26-year-old male with a history of 10 concussions, diagnosed for bipolar type II disorder, mild attention-deficit hyperactivity disorder, and a history of migraines/headaches. The case was medicated with Valproic Acid and Escitalopram. Sensor-based baseline data were collected within six months of his injury and on days 1–5, 10, and 14 post-injury. Symptom reporting, heart rate variability (HRV), neurovascular coupling (NVC), and dynamic cerebral autoregulation (dCA) assessments were completed using numerous biomedical devices (i.e., transcranial Doppler ultrasound, 3-lead electrocardiography, finger photoplethysmography). Results: Total symptom and symptom severity scores were higher for the first-week post-injury, with physical and emotional symptoms being the most impacted. The NVC response showed lowered activation in the first three days post-injury, while autonomic (HRV) and autoregulation (dCA) were impaired across all testing visits occurring in the first 14 days following his concussion. Conclusions: Despite symptom resolution, the case demonstrated ongoing autonomic and autoregulatory dysfunction. Larger samples examining individuals with an extensive history of concussion are warranted to understand the chronic physiological changes that occur following cumulative concussions through biosensing devices.

Frequency-domain near-infrared spectroscopy (FD-NIRS) has been used for non-invasive assessment of cortical oxygenation since the late 1990s. However, there is limited research demonstrating clinical validity and general reproducibility. To address this limitation, recording duration for adequate validity and within- and between-day reproducibility of prefrontal cortical oxygenation was evaluated. To assess validity, a reverse analysis of 10-min-long measurements (n = 52) at different recording durations (1–10-min) was quantified via coefficients of variation and Bland–Altman plots. To assess within- and between-day within-subject reproducibility, participants (n = 15) completed 2-min measurements twice a day (morning/afternoon) for five consecutive days. While 1-min recordings demonstrated sufficient validity for the assessment of oxygen saturation (StO2) and total hemoglobin concentration (THb), recordings ≥4 min revealed greater clinical utility for oxy- (HbO) and deoxyhemoglobin (HHb) concentration. Females had lower StO2, THb, HbO, and HHb values than males, but variability was approximately equal between sexes. Intraclass correlation coefficients ranged from 0.50–0.96. The minimal detectable change for StO2 was 1.15% (95% CI: 0.336–1.96%) and 3.12 µM for THb (95% CI: 0.915–5.33 µM) for females and 2.75% (95%CI: 0.807–4.70%) for StO2 and 5.51 µM (95%CI: 1.62–9.42 µM) for THb in males. Overall, FD-NIRS demonstrated good levels of between-day reliability. These findings support the application of FD-NIRS in field-based settings and indicate a recording duration of 1 min allows for valid measures; however, data recordings of ≥4 min are recommended when feasible.

Wearable technology and neuroimaging equipment using photoplethysmography (PPG) have become increasingly popularized in recent years. Several investigations deriving pulse rate variability (PRV) from PPG have demonstrated that a slight bias exists compared to concurrent heart rate variability (HRV) estimates. PPG devices commonly sample at ~20–100 Hz, where the minimum sampling frequency to derive valid PRV metrics is unknown. Further, due to different autonomic innervation, it is unknown if PRV metrics are harmonious between the cerebral and peripheral vasculature. Cardiac activity via electrocardiography (ECG) and PPG were obtained concurrently in 54 participants (29 females) in an upright orthostatic position. PPG data were collected at three anatomical locations: left third phalanx, middle cerebral artery, and posterior cerebral artery using a Finapres NOVA device and transcranial Doppler ultrasound. Data were sampled for five minutes at 1000 Hz and downsampled to frequencies ranging from 20 to 500 Hz. HRV (via ECG) and PRV (via PPG) were quantified and compared at 1000 Hz using Bland–Altman plots and coefficient of variation (CoV). A sampling frequency of ~100–200 Hz was required to produce PRV metrics with a bias of less than 2%, while a sampling rate of ~40–50 Hz elicited a bias smaller than 20%. At 1000 Hz, time- and frequency-domain PRV measures were slightly elevated compared to those derived from HRV (mean bias: ~1–8%). In conjunction with previous reports, PRV and HRV were not surrogate biomarkers due to the different nature of the collected waveforms. Nevertheless, PRV estimates displayed greater validity at a lower sampling rate compared to HRV estimates.

Abstract Dynamic cerebral autoregulation (dCA) describes the regulation of cerebral blood flow (CBF) in response to fluctuations in systemic blood pressure (BP). Heavy resistance exercise is known to induce large transient elevations in BP, which are translated into perturbations of CBF, and may alter dCA in the immediate aftermath. This study aimed to better quantify the time course of any acute alterations in dCA after resistance exercise. Following familiarisation to all procedures, 22 (14 male) healthy young adults (22 ± 2 years) completed an experimental trial and resting control trial, in a counterbalanced order. Repeated squat‐stand manoeuvres (SSM) at 0.05 and 0.10 Hz were used to quantify dCA before, and 10 and 45 min after four sets of ten repetition back squats at 70% of one repetition maximum, or time matched seated rest (control). Diastolic, mean and systolic dCA were quantified by transfer function analysis of BP (finger plethysmography) and middle cerebral artery blood velocity (transcranial Doppler ultrasound). Mean gain (p = 0.02; d = 0.36) systolic gain (p = 0.01; d = 0.55), mean normalised gain (p = 0.02; d = 0.28) and systolic normalised gain (p = 0.01; d = 0.67) were significantly elevated above baseline during 0.10 Hz SSM 10‐min post resistance exercise. This alteration was not present 45 min post‐exercise, and dCA indices were never altered during SSM at 0.05 Hz. dCA metrics were acutely altered 10 min post resistance exercise at the 0.10 Hz frequency only, which indicate changes in the sympathetic regulation of CBF. These alterations recovered 45 min post‐exercise.

Abstract We previously reported subtle dynamic cerebral autoregulation (dCA) alterations following 6 weeks of high‐intensity interval training (HIIT) to exhaustion using transfer function analysis (TFA) on forced mean arterial pressure (MAP) oscillations in young endurance‐trained men. However, accumulating evidence suggests the cerebrovasculature better buffers cerebral blood flow changes when MAP acutely increases compared to when MAP acutely decreases. Whether HIIT affects the directional sensitivity of the cerebral pressure‐flow relationship in these athletes is unknown. In 18 endurance‐trained men (age: 27 ± 6 years, VO2max: 55.5 ± 4.7 ml·kg−1·min−1), we evaluated the impact of 6 weeks of HIIT to exhaustion on dCA directionality using induced MAP oscillations during 5‐min 0.05 and 0.10 Hz repeated squat‐stands. We calculated time‐adjusted changes in middle cerebral artery mean blood velocity (MCAv) per change in MAP (ΔMCAvT/ΔMAPT) for each squat transition. Then, we compared averaged ΔMCAvT/ΔMAPT during MAP increases and decreases. Before HIIT, ΔMCAvT/ΔMAPT was comparable between MAP increases and decreases during 0.05 Hz repeated squat‐stands (p = 0.518). During 0.10 Hz repeated squat‐stands, ΔMCAvT/ΔMAPT was lower during MAP increases versus decreases (0.87 ± 0.17 vs. 0.99 ± 0.23 cm·s−1·mmHg−1, p = 0.030). Following HIIT, ΔMCAvT/ΔMAPT was superior during MAP increases over decreases during 0.05 Hz repeated squat‐stands (0.97 ± 0.38 vs. 0.77 ± 0.35 cm·s−1·mmHg−1, p = 0.002). During 0.10 Hz repeated squat‐stands, dCA directional sensitivity disappeared (p = 0.359). These results suggest the potential for HIIT to influence the directional sensitivity of the cerebral pressure‐flow relationship in young endurance‐trained men.

Abstract Sinusoidal squat‐stand maneuvers (SSM) without resistance have been shown to produce ~30–50 mmHg swings in mean arterial pressure which are largely buffered in the brain via dynamic cerebral autoregulation (dCA). This study aimed to further elucidate how this regulatory mechanism is affected during SSM with added resistance (~20% bodyweight). Twenty‐five participants (sex/gender: 13 females/12 males) completed two bouts of 5‐min SSM for both bodyweight and resistance conditions (10% bodyweight in each arm) at frequencies of 0.05 Hz (20‐s squat/stand cycles) and 0.10 Hz (10‐s squat/stand cycles). Middle and posterior cerebral artery (MCA/PCA) cerebral blood velocities were indexed with transcranial Doppler ultrasound. Beat‐to‐beat blood pressure (BP) was quantified via finger photoplesmography. Transfer function analysis was employed to quantify dCA in both cerebral arteries across the cardiac cycle (diastole, mean, and systole). Two‐by‐two Analysis of Variance with generalized eta squared effect sizes were utilized to determine differences between resistance vs. bodyweight squats and between sexes/genders. Absolute mean and diastolic BP were elevated during the resistance squats (p 0.067); however, females displayed attenuated systolic regulation (p

Abstract A simple bodyweight squat is sufficient to cause substantial stress on the autonomic nervous system (ANS) via ~30–50 mmHg blood pressure (BP) oscillations. However, it is unknown to the extent of the ANS is impacted during and immediately following bodyweight and resistance squat‐stand maneuvers (SSM) while considering chromosomal sex. Thirteen females and twelve males performed four, 5‐minute bouts of squat‐stand maneuvers (SSM); two at 0.05 Hz (10‐second squat/10‐second stand) and two at 0.10 Hz (5‐s squat/5‐s stand). The SSM were performed using bodyweight resistance and additional external resistance (~20% of bodyweight). Five‐minutes of quiet‐sitting and quiet‐standing were completed immediately following both bodyweight and resistance squats. Heart rate variability (HRV) and baroreceptor sensitivity metrics were extracted from beat‐to‐beat electrocardiography and systemic BP recordings. Repeated measure Analysis of Variance with generalized eta‐squared effect sizes assessed differences between SSM task type and chromosomal sex on ANS metrics. Despite added resistance eliciting greater elevations in blood pressure, no differences in ANS function were noted during competition and recovery between SSM tasks (all p > 0.050; negligible/small effect sizes). During recovery, females had an elevated heart rate (p = 0.017; small effect size), greater time‐domain HRV measures (p

Abstract Background While previous studies have demonstrated a complex visual scene search elicits a robust neurovascular coupling (NVC) response, it is unknown how the duration of visual stimuli presentation influences NVC metrics. This study examined how stimuli duration, in addition to biological sex and self‐reported engagement impact NVC responses. Methods Participants (n = 20, female = 10) completed four visual paradigms. Three involved simple visual shapes presented at 0.5‐, 2‐, and 4‐s intervals in randomized orders. The fourth paradigm was a complex visual scene search (“Where's Waldo?”). Participants completed eight cycles of 20‐s eyes‐closed followed by 40‐s eyes‐open. Transcranial Doppler ultrasound indexed posterior and middle cerebral artery velocities (PCA and MCA). Participants self‐reported their engagement following each task (1 [minimal] to 10 [maximal]). Results The “Where's Waldo?” task evoked greater PCA percent increase (all p

Abstract In 1959, Niels Lassen illustrated the cerebral autoregulation curve in the classic review article entitled Cerebral Blood Flow and Oxygen Consumption in Man. This concept suggested a relatively broad mean arterial pressure range (~60–150 mmHg) wherein cerebral blood flow remains constant. However, the assumption that this wide cerebral autoregulation plateau could be applied on a within‐individual basis is incorrect and greatly variable between individuals. Indeed, each data point on the autoregulatory curve originated from independent samples of participants and patients and represented interindividual relationships between cerebral blood flow and mean arterial pressure. Nonetheless, this influential concept remains commonly cited and illustrated in various high‐impact publications and medical textbooks, and is frequently taught in medical and science education without appropriate nuances and caveats. Herein, we provide the rationale and additional experimental data supporting the notion we need to lose this dogmatic view of cerebral autoregulation.

Background: Heart rate variability (HRV) is a popular tool to quantify autonomic function. However, this typically requires an expensive 3–12 lead electrocardiogram (ECG) and BioAmp system. This investigation sought to determine the validity and reliability of an OpenBCI cyton biosensing board (open source) for accurately quantifying HRV. New method: A cyton board with a 3-lead ECG was employed to acquire heart rate waveform data, which was processed to obtain HRV within both time- and frequency-domains. The concurrent validity was compared to a simultaneous recording from an industry-standard 3-lead ECG (ADInstruments) (n = 15). The reliability of the cyton board was compared between three days within a 7-day timespan (n = 10). Upright quiet-stance short-term HRV metrics were quantified in time- and frequency-domains. Results: The two devices displayed excellent limits of agreements (all log mean differences ±0.4) and very high between-device variable associations (all r2 > 0.98). Between the three time points in the same subjects, no differences were noted within time- (all p > 0.71) or frequency-domains (all p > 0.88) across testing points. Finally, all HRV metrics exhibited excellent levels of reliability through high Cronbach's Alpha (all ≥0.916) and intraclass correlation coefficients (all ≥0.930); and small standard error of the measurement (all ≤0.7) and typical error of the measurement (all ≤0.1) metrics. Comparison with existing methods: The cyton board with 3-lead ECG was compared with an industry-standard ADInstruments ECG during HRV assessments. There were no significant differences between devices with respect to time- and frequency-domains. The cyton board displayed high-levels of between-day reliability and provided values harmonious to previous ECG literature highlighting the applicability for longitudinal studies. Conclusion: With proper background knowledge regarding ECG principles and a small degree of set-up complexity, an open source cyton board can be created and employed to perform multimodal HRV assessments at a fraction of the cost (~4%) of an industry-standard ECG setup.

Abstract Purpose Studies examining neurovascular coupling (NVC) require participants to refrain from exercise for 12–24 hours. However, there is a paucity of empirical evidence for this restriction. The objectives for this study were to delineate the time‐course recovery of NVC metrics following exercise and establish the NVC within‐ and between‐day reliability. Methods Nine participants completed a complex visual search paradigm to assess NVC via transcranial Doppler ultrasound of the posterior cerebral artery blood velocity (PCA). Measurements were performed prior to and throughout the 8‐hour recovery period following three randomized conditions: 45 minutes of moderate‐intensity exercise (at 50% heart‐rate reserve), 30 minutes high‐intensity intervals (10, 1‐minute intervals at 85% heart‐rate reserve), and control (30 minutes quiet rest). In each condition, baseline measures were collected at 8:00am with serial follow‐ups at hours zero, one, two, four, six, and eight. Results Area‐under‐the‐curve and time‐to‐peak PCA velocity during the visual search were attenuated at hour zero following high‐intensity intervals (all p 0.13). Conversely, baseline PCA velocity, peak PCA velocity, and the relative percent increase were not different following high‐intensity intervals compared to baseline (all p > 0.26). No NVC metrics differed from baseline following both moderate exercise and control conditions (all p > 0.24). The majority of the NVC parameters demonstrated high levels of reliability (intraclass correlation coefficient: >0.90). Conclusion Future NVC assessments can take place a minimum of one hour following exercise. Moreover, all metrics did not change across the control condition, therefore future studies using this methodology can reliably quantify NVC between 8:00am and 7:00 pm.

Objective: The current investigation examined how a bout of soccer heading may impact brain function.Design: Semi-randomized crossover cohort.Setting: Controlled soccer heading.Participants: Seven male soccer players (24.1 ± 1.5 years).Intervention: 40 successful soccer headers were performed in 20 min (25 m, launch velocity ~80 km/h). X2 xPatch recorded linear and rotational head accelerations during each impact. A contact control “sham” condition – ball made body contact, but not by the head; and a no activity time “control” condition were also completed.Main Outcome Measures: Posterior and middle cerebral artery (PCA and MCA, respectively), cerebral blood velocity (CBV) was recorded during a visual task (neurovascular coupling: NVC) alongside SCAT3 symptoms scores pre/post a controlled bout of soccer heading.Results: Cumulative linear and rotational accelerations were 1,574 ± 97.9 g and 313,761 ± 23,966 rads/s2, respectively, during heading and changes in SCAT3 symptom number (pre: 2.6 ± 3.0; post: 6.7 ± 6.2, p = 0.13) and severity (pre: 3.7 ± 3.6, post: 9.4 ± 7.6, p = 0.11) were unchanged. In the PCA, no NVC differences were observed, including: relative CBV increase (28.0 ± 7.6%, p = 0.71) and total activation (188.7 ± 68.1 cm, p = 0.93). However, MCA-derived NVC metrics were blunted following heading, demonstrating decreased relative CBV increase (7.8 ± 3.1%, p = 0.03) and decreased total activation (26.7 ± 45.3 cm, p = 0.04).Conclusion: Although an acute bout of soccer heading did not result in an increase of concussion-like symptoms, there were alterations in NVC responses within the MCA during a visual task. This suggests an acute bout of repetitive soccer heading can alter CBV regulation within the region of the brain associated with the header impacts.

Abstract Presently, the literature describing the influence of diurnal variation on dynamic cerebral autoregulation (dCA) metrics is sparse. Additionally, there is little data with respect to dCA comparisons between anterior/posterior circulation beds and biological sexes using squat‐stand maneuvers. Eight male and eight female participants (n = 16) performed 5 min of spontaneous upright rest and squat‐stand maneuvers at 0.05 and 0.10 Hz across seven time points throughout the day. All testing sessions commenced at 8:00 a.m. each day and dCA parameters were quantified across the cardiac cycle (diastole, mean, and systole) using transcranial Doppler ultrasound to insonate cerebral blood velocity within the middle and posterior cerebral arteries (MCA, PCA). No cardiac cycle alternations were seen spontaneous (all p > .207) while a trend was noted in some driven (all p > .051) dCA metrics. Driven dCA produced much lower coefficient of variances (all .096). Between vessels, PCA absolute gain was reduced within all spontaneous and driven measures (all p .099). There appears to be little influence of diurnal variation on dCA measures across the day (8:00 a.m. to 6:00 p.m.). Absolute gain was blunted in the PCA relative to the MCA and consistent with previous literature, driven methods demonstrated vastly improved reproducibility metrics compared to spontaneous methods. Finally, no dCA differences were found between biological sexes, demonstrating that males and females regulate in a harmonious manner, when females are tested within the early follicular phase of the menstrual cycle.

Abstract A common inclusion criterion when assessing cerebrovascular (CVR) metrics is for individuals to abstain from exercise for 12–24 hr prior to data collections. While several studies have examined CVR during exercise, the literature describing CVR throughout post‐exercise recovery is sparse. The current investigation examined CVR measurements in nine participants (seven male) before and for 8 hr following three conditions: 45‐min moderate‐continuous exercise (at ~50% heart‐rate reserve), 25‐min high‐intensity intervals (ten, one‐minute intervals at ~85% heart‐rate reserve), and a control day (30‐min quiet rest). The hypercapnic (40–60 mmHg) and hypocapnic (25–40 mmHg) slopes were assessed via a modified rebreathing technique and controlled stepwise hyperventilation, respectively. All testing was initiated at 8:00a.m. with transcranial Doppler ultrasound measurements to index cerebral blood velocity performed prior to the condition (pre) with serial follow‐ups at zero, one, two, four, six, and eight hours within the middle and posterior cerebral artery (MCA, PCA). Absolute and relative MCA and PCA hypercapnic slopes were attenuated following high‐intensity intervals at hours zero and one (all p .13), aside from a reduced relative hypercapnic MCA slope at hours zero and one following moderate‐continuous exercise (all p

Abstract Background An integrated curriculum is designed to be repetitive yet progressive and the concept has rapidly established itself within medical education. National organizations have recommended a shift to a spiral curriculum design, which uses both vertical and horizontal integration. This study examined differences between the recently implemented integrated spiral (class of 2019) and conventional block (classes of 2016–2018) MD curricula at the University of British Columbia (UBC) with respect to knowledge of concussion. Methods Cross-sectional online survey (FluidSurveys: Fluidware, Ottawa, ON), distributed via email to UBC medical students during the 2015–2016 academic year. Questions focused on demographic data, knowledge of concussion definition, and management considerations. Differences in responses across the two groups were assessed using chi-square tests. Ordinal Likert-scale data were analyzed using Mann-Whitney U-Tests. Statistical significance was determined a priori at p

Abstract Current protocols examining cerebral autoregulation (CA) parameters require participants to refrain from exercise for 12–24 hr, however there is sparse objective evidence examining the recovery trajectory of these measures following exercise across the cardiac cycle (diastole, mean, and systole). Therefore, this study sought to determine the duration acute exercise impacts CA and the within‐day reproducibility of these measures. Nine participants performed squat–stand maneuvers at 0.05 and 0.10 Hz at baseline before three interventions: 45‐min moderate‐continuous exercise (at 50% heart‐rate reserve), 30‐min high‐intensity intervals (ten, 1‐min at 85% heart‐rate reserve), and a control day (30‐min quiet rest). Squat–stands were repeated at hours zero, one, two, four, six, and eight after each condition. Transcranial doppler ultrasound of the middle cerebral artery (MCA) and the posterior cerebral artery (PCA) was used to characterize CA parameters across the cardiac cycle. At baseline, the systolic CA parameters were different than mean and diastolic components (ps 0.079). In the PCA, phase values were affected only following high‐intensity intervals until hour four (ps > 0.055). Normalized gain in all cardiac cycle domains remained different following both exercise protocols (ps

Repetitive subconcussive head impacts across a season of contact sports participation are associated with a number of deficits in brain function. To date, no research has investigated the effect of such head impact exposure on dynamic cerebral autoregulation (dCA). To address this issue, 179 elite, junior-level (age 19.6 ± 1.5 years) contact sport (ice hockey, American football) athletes were recruited for pre-season testing. Fifty-two non-concussed athletes returned for post-season testing. Fifteen non-contact sport athletes (age 20.4 ± 2.2) also completed pre- and postseason testing. dCA was assessed via recordings of beat-by-beat mean arterial pressure (MAP) and middle cerebral artery blood velocity (MCAv) using finger photoplethysmography and transcranial Doppler ultrasound, respectively, during repetitive squat-stand maneuvers at 0.05 and 0.10 Hz. Transfer function analysis was used to determine Coherence (correlation), Gain (response amplitude), and Phase (response latency) of the MAP-MCAv relationship. Results showed that in contact sport athletes, Phase was reduced (p = 0.027) and Gain increased (p < 0.001) at post-season compared to pre-season during the 0.10 Hz squat-stand maneuvers, indicating cerebral autoregulatory impairment in both the latency and magnitude of the response. Changes in Phase were greater in athletes experiencing higher numbers and severity of head impacts. By contrast, no changes in dCA were observed in non-contact sport controls. Taken together, these results demonstrate that repetitive subconcussive head impacts occurring across a season of contact sports participation are associated with exposure-dependent impairments in the cerebrovascular pressure-buffering system capacity. It is unknown how long these deficits persist or if they accumulate year-over-year.

Sport-related concussion is known to affect a variety of brain functions. However, the impact of this brain injury on cerebral autoregulation (CA) is poorly understood. Thus, the goal of the current study was to determine the acute and cumulative effects of sport-related concussion on indices of dynamic CA. Toward this end, 179 elite, junior-level (age 19.6 ± 1.5 years) contact sport (ice hockey, American football) athletes were recruited for preseason testing, 42 with zero prior concussions and 31 with three or more previous concussions. Eighteen athletes sustained a concussion during that competitive season and completed follow-up testing at 72 h, 2 weeks, and 1 month post injury. Beat-by-beat arterial blood pressure (BP) and middle cerebral artery blood velocity (MCAv) were recorded using finger photoplethysmography and transcranial Doppler ultrasound, respectively. Five minutes of repetitive squat–stand maneuvers induced BP oscillations at 0.05 and 0.10 Hz (20- and 10-s cycles, respectively). The BP–MCAv relationship was quantified using transfer function analysis to estimate Coherence (correlation), Gain (amplitude ratio), and Phase (timing offset). At a group level, repeated-measures ANOVA indicated that 0.10 Hz Phase was significantly reduced following an acute concussion, compared to preseason, by 23% (−0.136 ± 0.033 rads) at 72 h and by 18% (−0.105 ± 0.029 rads) at 2 weeks post injury, indicating impaired autoregulatory functioning; recovery to preseason values occurred by 1 month. Athletes were cleared to return to competition after a median of 14 days (range 7–35), implying that physiologic dysfunction persisted beyond clinical recovery in many cases. When comparing dynamic pressure buffering between athletes with zero prior concussions and those with three or more, no differences were observed. Sustaining an acute sport-related concussion induces transient impairments in the capabilities of the cerebrovascular pressure-buffering system that may persist beyond 2 weeks and may be due to a period of autonomic dysregulation. Athletes with a history of three or more concussions did not exhibit impairments relative to those with zero prior concussions, suggesting recovery of function over time. Findings from this study support the potential need to consider physiological recovery in deciding when patients should return to play following a concussion.