Innovative Approaches to Treating and Preventing Concussions (10/3/19 newsletter)
We are pleased to have Carleton College students and alumni interning with Concussion Alliance. Intern contributors this week:
Editor: Galen Moller
Contributors: Galen Moller and Julian Szieff.
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High school uses virtual reality goggles and CrashCourse video for concussion education
Student-athletes at Bryant High School in Arkansas are using virtual reality to recognize concussion symptoms, according to an article in ABC On Your Side. The main goal of the program is to raise awareness so that students will be able to make well-informed decisions if they experience an injury to the head and/or notice concussion-like symptoms. The training is done using VR goggles to experience the CrashCourse interactive video created by the nonprofit Teachaids.org. The article also has a news video that shows the student-athletes using the goggles and interviews a student-athlete who has used the VR goggles.
Full disclosure: Concussion Alliance is now partnering with Teachaids to present CrashCourse, but had no relation to the use of TeachAids materials in Arkansas.
Study confirms that limited contact during practice reduces rates of sports-related injuries
In 2014, the Wisconsin Interscholastic Athletic Association passed new rules that limited contact during high school football practices. Pfaller et al. compared rates of sports-related injuries in high school football players before and after the rule change, and found that the rate of sports-related injuries during practices decreased by 57% when there was limited contact. There was no change in the rate of concussions sustained during competitions. Their research, which was published in The American Journal of Sports Medicine, supports the theory that limiting contact during football practice could be an effective strategy for reducing the total number of sports-related injuries in high school athletes.
Is it safe to vape in order to reduce my concussion symptoms?
In the article “What Should We Do About Vaping?” the well-respected nonprofit Project CBD addresses the current vaping healthcare crisis. Over 500 people have been hospitalized, and there have been 12 deaths due to vaping. Although some were using e-cigarettes, most of those stricken with vaping-related lung disease were vaping THC from “poor quality, unlicensed cannabis products.” However, there has been at least one death and one case of illness due to vaping products from legal cannabis stores.
Information about this healthcare crisis may be of interest to concussion patients. One of our blog posts covers research indicating that concussion patients were finding relief from acute pain (for example, severe headaches) by using a vapor pen with a combination of THC and CBD.
The CDC has not conclusively linked any particular substance to the vaping disease incidents, but the most likely culprits are chemical additives commonly used as thinning and flavoring agents in food. The FDA has approved many of these substances for ingestion, but these substances may be unsafe when heated and inhaled because “heating and combustion can change a compound into something much more dangerous than the original.”
Project CBD adds, “Let’s be clear: inhaling additive-free, artisanal whole-plant cannabis oil with a well-made vaping device is just as safe, if not more so than smoking organically grown cannabis.”
Leaky axons and short term memory; A new severity indicator for TBI
One of the goals of neurologic TBI research is finding clear indicators that show if a TBI will result in long-term symptoms. Researchers Chung et al. recently published a study in The American Journal of Neuroradiology that discusses a potential severity indicator for concussion. The researchers found that in TBI patients, the severity of neuron damage as measured by MRI was a predictor of working memory ability. This predictive power was not present in the healthy control group. The study is taking advantage of diffusion MRI technology, which measures fluid movement in and out of nerve fibers as a measure of axonal damage.
Hopefully, the findings from this study can be extrapolated to create an MRI test that will predict TBI severity and inform the treatment of recovering patients.
A detailed explanation of aerobic exercise as a therapy
Neurology Consultant interviewed John Leddy M.D., a clinician and pioneering researcher into the utility of exercise in concussion recovery. This interview will be particularly useful to healthcare providers, but can also help concussion advocates, as Dr. Leddy provides precise information on the therapeutic use of aerobic exercise. For example, Dr. Leddy discusses how to prescribe “subsymptom threshold exercise treatment.” He says that at the University at Buffalo, they are now prescribing aerobic exercise, performed with a target heart rate that is “90% of the heart rate achieved at the symptom exacerbation threshold on the Buffalo concussion treadmill test.” They recommend a frequency of 5 to 7 days per week.
In other recommendations, Dr. Leddy says that patients should begin cervical (neck) rehabilitation as soon as a cervical injury is identified. In contrast, vestibular and vision rehabilitation are typically not initiated until a delayed recovery is identified (2 weeks for adults, 4 weeks for adolescents) because usually, these subsystems heal on their own.
We’ve written about exercise as a therapy several times, most recently in our September 12 newsletter.
Also see: "New feedback and relaxation device being tested for PTSD and TBI in soldiers" In the Military Service Members & Veterans category
New feedback and relaxation device being tested for PTSD and TBI in soldiers
Forty-five soldiers who are at high risk for TBI are testing a new technology to relieve their symptoms at two military medical facilities, according to an article in The Fayetteville Observer. They are taking part in a $2.8 million research study which is testing the use of a device designed by Cereset; the device uses electrodes attached to the skin of the forehead to read brainwaves. The Cereset neurotechnology then translates the brainwaves into piano tones that are played back to the patient. The mechanism the brain uses to monitor and adjust itself to these tones is currently unknown, but there have been numerous reports of this technology's benefits, including improved sleep quality and reduced stress in military personnel with PTSD. This is the first time this technology has been researched with TBI, but at least one former NFL player has endorsed Cereset as reducing his chronic sleep, focus, and stress symptoms.
Looking on the bright side; optimism found to be associated with improved recovery
The impact of psychology on recovery has been studied in many diseases, but it is an expanding subject in concussion and TBI. Researchers at Icahn School of Medicine at Mount Sinai recently published a study in Brain Injury examining if optimism can affect TBI recovery. The researchers evaluated the optimism and cognitive ability of 171 individuals with different TBI severity using two standardized tests. Adjusting for age, severity of illness, and other health factors, they found that if someone was more optimistic, they were more likely to have a higher cognitive functioning level after TBI.
One question this study fails to address is whether optimism is a factor that protects people from more severe concussion symptoms or if optimism aids recovery specifically. This study only measured post-concussion optimism, so the patient’s pre-concussion optimism baseline was unknown. The research team is encouraging more research into possible optimism interventions to help patients.
Racial differences in ER visits for children and adolescents with sports-related injuries
A study by Lyons et al. sought to determine whether there were racial differences in emergency room visits for pediatric sports-related head injuries. They found that head injuries were less common among black children who were brought to the emergency room for a sports-related injury than they were among non-Hispanic white children. They also found that the black children who were brought to the emergency room for a head injury were less likely to be diagnosed with a concussion than non-Hispanic white children. The researchers do not attempt to determine why these differences exist, but state that further research is merited “to ensure all brain-injured athletes receive optimal care, regardless of race.” The study was published in Frontiers in Neurology.
Differences in the axons in female brains may contribute to more vulnerability to concussion
Dr. Doug Smith, a preeminent concussion expert, suggests that differences in the anatomy of the female brain may contribute to higher rates of concussion and longer recovery times in women and girls. In an article for the International Concussion Society, Dr. Smith points to diffuse axonal injury, or injury to the nerve fibers in the brain, as the predominant injury in a concussion.
Recent research has discovered a difference, on a nanoscale, between the axons of male and female brains. Females appear to have a more complex brain axon network than males. Containing this increased complexity in the smaller female skull creates differences in "the architecture and size of the axons" in female brains. Consequently, these differences could mean that for the same mechanical force, female brains are more likely to sustain damage.
Rob Gronkowski’s recent tweets showcase what people often miss in conversations about CTE and concussions
Rob Gronkowski, a well-known retired NFL player, recently made a post on Twitter in which he appears to claim that CBD fixed his CTE and concussion symptoms after suffering 20 concussions. He also announced he was partnering with CBDMEDIC, a CBD product manufacturer. The Guardian reports that Chris Nowinski, co-founder and CEO of the Concussion Legacy Foundation, was concerned by Gronkowski’s tweets because they make the mistake of equating a lack of symptoms with recovery. Often symptoms can get better and worse in waves or will only surface during times of stress or with another impact. Nowinski also says he believes that “Gronkowski has been able to find relief for his post-concussion symptoms, rather than symptoms of CTE.”
Gronkowski has since revised his comments about concussion symptoms. He says, “I am not saying I cured it. I am saying that I put in the time, the effort & willingness to find unconventional methods to improve my conditions.”
Executive Editor (and Contributor)
Concussion Alliance co-founder Malayka Gormally