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Abstract
Interest in concussion has prompted an explosion of scientific literature, yet prominent gaps persist in research. This doctoral work has utilized an integrative sciences approach to investigate sex- and assault-specific differences post concussion across neural organization and functional outcomes respectively. Our scoping review confirms that the exploration of ‘sex’ as a biological variable and its influence on outcomes post concussion remains under-investigated. To date, only 0.7% of the adult concussion-related neuroimaging literature (n=669) has completed sex stratified analyses. Given the dearth of sex-stratified evidence and the lack of consideration for contextual factors, sound interpretations of subgroup vulnerability estimates are challenging. Next, through an original study, we provide evidence using a large sample (n=111) of post concussive individuals that sex-specific alteration in large-scale neural networks exist across both sexes; but that these alterations occur in distinct networks. Finally, a macro-scale population-based approach was employed to understand the sex-specific ‘functional’ impact of concussion within the context of days off work using an administrative claims database (n=3,129). Given the paucity of research regarding assault, as a mechanism of injury, after characterizing the sample by sex based on demographic and workplace variables and then explored whether workers who sustained work-related-mTBI-assault were more likely to take days off work, compared to those injured from other mechanisms; and if there was a sex-specific effect. We found that assault independently predicted time away from work but there were no statistical differences between sexes. We discuss the need to re-examine the complexities of the person-work-environment within the context of assault-related concussions and issue a call for practitioners to consider mechanism of injury as a possible influencer of outcome. This doctoral work has extensive applications for rehabilitation sciences, including consideration of sex-tailored remediation interventions and consideration of sex and mechanism of injury in clinical guidelines for concussion.
