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The Fundamental Frequency: A New Approach to Concussion Diagnosis in Children

  • Brett Ostrander and Janice Blumer
Published/Copyright: May 1, 2017
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Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 117 Issue 5

Kraus N, Thompson EC, Krizman J, Cook K, White-Schwoch T, LaBella CR. Auditory biological marker of concussion in children. Sci Rep. 2016;6:39009. doi:10.1038/srep39009

Concussions are increasingly being identified as a significant health concern, especially among children who participate in sport-related activities. Approximately 1.6 to 3.8 million traumatic brain injuries (TBIs) occur each year in the United States1 and result in neurocognitive sequelae that can affect the physical, social, and emotional well-being of children who sustain them. Despite the potential negative effects of TBIs, there is no reliable, objective test to effectively identify and assess the severity of concussion or TBI. Because of the broad symptoms that frequently present after sustaining a concussion and the subjective reporting of those symptoms, researchers at Northwestern University sought to determine whether concussions could be identified and stratified in severity based on an auditory biological marker, the frequency following response (FFR). The FFR is an evoked potential of the nervous system relating to the auditory brainstem response. After a concussive episode, demyelination, axonal injury, and tau protein accumulation have all been established as potential corollary to damage within the neocortex.2 Thus, the researchers hypothesized that there would be a measurable disruption in the processing of the fundamental frequency (F0), an acoustic cue that facilitates pitch perception and identification of sound, and the ability to understand rhythm and stress in speech in patients with a concussion. They predicted that the disruption would result in delayed and smaller response of the FFR.

The researchers evaluated 2 groups of children (N=40) (mean age, 13.32 years), 1 group of children with concussion and a matched control group of children. Children in the concussion group were evaluated at an average 27 days after injury using a Bio-logic Navigator Pro System (Natus Medical Inc), which delivered the F0 and collected responses measuring how quickly and accurately the F0 was processed.

Results showed a significant difference in processing of the F0 between the concussion and control groups in amplitude and timing. Specifically, researchers found that processing of the F0 is disrupted, and a diminished neural response to speech was observed after concussion. The response rate to the F0 of children in the concussion group was about 35% smaller than that of the control group. Additionally, a clinically significant difference was found in the timing of neural processing between the children in each group. Children with concussion were an average of 0.4 milliseconds slower than the children in the control group.

In this study, FFR was shown to identify a concussion with a positive predictive value of 94.7% and a negative predictive value of 90.4%, which is demonstrably higher than the Immediate Post-Concussion Assessment and Cognitive Test.3 Limitations of this study include its small sample size and a potentially biased sample of children in the concussion group, as they had already sought tertiary care for their symptoms.

These findings support the hypothesis that auditory biomarkers can play a role in the diagnosis and management of concussion and other TBIs in children as a noninvasive and objective measure of neural processing. Further research is necessary to examine potential causality and feasibility of the measurement of FFR on a practical scale.

Western University of Health Science College of Osteopathic Medicine of the Pacific-Northwest, Lebanon, Oregon

References

1. Langlois JA , Rutland-BrownW, WaldMM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil. 2006;21(5):375-378.10.1097/00001199-200609000-00001Search in Google Scholar PubMed

2. McKee AC , CantuR, NowinskiCJ, et al. Chronic traumatic encephalopathy in athletes: progressive tauopathy following repetitive head injury. J Neuropathol Exp Neurol. 2009;68(7):709-735. doi:10.1097/NEN.0b013e3181a9d503Search in Google Scholar PubMed PubMed Central

3. Schatz P , PardiniJE, LovellMR, CollinsMW, PodellK. Sensitivity and specificity of the ImPACT Test Battery for concussion in athletes. Arch Clin Neuropsychol. 2006;21(1):91-99. doi:10.1016/j.acn.2005.08.001Search in Google Scholar PubMed

Published Online: 2017-05-01
Published in Print: 2017-05-01

© 2017 American Osteopathic Association

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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  1. EDITORIAL
  2. 10.7556/jaoa.2017.049
  3. LETTERS TO THE EDITOR
  4. Osteopathic Manipulative Treatment During the Third Trimester of Pregnancy
  5. RESPONSE
  6. Response
  7. CORRECTION
  8. Correction
  9. AOA COMMUNICATION
  10. Official Call: 2017 Annual Business Meeting of the American Osteopathic Association
  11. ORIGINAL CONTRIBUTION
  12. Employer-Funded Complete Health Improvement Program: Preliminary Results of Biomarker Changes
  13. EVIDENCE-BASED CLINICAL REVIEW
  14. Vitamin D Deficiency, Its Role in Health and Disease, and Current Supplementation Recommendations
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  18. Preparing Physicians for Rural-Based Primary Care Practice: A Preliminary Evaluation of Rural Training Initiatives at OSU-COM
  19. SPECIAL COMMUNICATION
  20. Introducing High School Students to Careers in Osteopathic Medicine
  21. THE SOMATIC CONNECTION
  22. Cardiorespiratory Benefit of Aerobic Exercise for Patients With Asthma
  23. Cost-Effective Management of Low Back and Joint Pain by Specialty
  24. Benefit of OMT in Patients Who Underwent Heart Surgery
  25. Addition of Osteopathic Visceral Manipulation to OMT for Low Back Pain Decreases Pain and Increases Quality of Life
  26. Effectiveness of OMT and OCMM for Temporomandibular Disorders
  27. Noninvasive Interventions Efficacious in Reducing Symptoms of Low Back Pain
  28. The Fundamental Frequency: A New Approach to Concussion Diagnosis in Children
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https://doi.org/10.7556/jaoa.2017.065
Creative Commons
BY-NC-ND 4.0

Articles in the same Issue

  1. EDITORIAL
  2. 10.7556/jaoa.2017.049
  3. LETTERS TO THE EDITOR
  4. Osteopathic Manipulative Treatment During the Third Trimester of Pregnancy
  5. RESPONSE
  6. Response
  7. CORRECTION
  8. Correction
  9. AOA COMMUNICATION
  10. Official Call: 2017 Annual Business Meeting of the American Osteopathic Association
  11. ORIGINAL CONTRIBUTION
  12. Employer-Funded Complete Health Improvement Program: Preliminary Results of Biomarker Changes
  13. EVIDENCE-BASED CLINICAL REVIEW
  14. Vitamin D Deficiency, Its Role in Health and Disease, and Current Supplementation Recommendations
  15. CLINICAL PRACTICE
  16. An Osteopathic Approach to Chronic Pain Management
  17. MEDICAL EDUCATION
  18. Preparing Physicians for Rural-Based Primary Care Practice: A Preliminary Evaluation of Rural Training Initiatives at OSU-COM
  19. SPECIAL COMMUNICATION
  20. Introducing High School Students to Careers in Osteopathic Medicine
  21. THE SOMATIC CONNECTION
  22. Cardiorespiratory Benefit of Aerobic Exercise for Patients With Asthma
  23. Cost-Effective Management of Low Back and Joint Pain by Specialty
  24. Benefit of OMT in Patients Who Underwent Heart Surgery
  25. Addition of Osteopathic Visceral Manipulation to OMT for Low Back Pain Decreases Pain and Increases Quality of Life
  26. Effectiveness of OMT and OCMM for Temporomandibular Disorders
  27. Noninvasive Interventions Efficacious in Reducing Symptoms of Low Back Pain
  28. The Fundamental Frequency: A New Approach to Concussion Diagnosis in Children
  29. CLINICAL IMAGES
  30. Pacemaker Twiddler Syndrome
  31. Retroperitoneal Fibrosis
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