Light therapy a potential treatment for probable CTE symptoms (7/11/19 newsletter)
We are pleased to have students from Carleton College interning with Concussion Alliance. Intern contributors this week:
Editor: Galen Moller
Contributors: Eloïse Cowan, Micalie Hunt, Hannah Kennicott, and Julian Szieff.
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The Mayo Clinic has established a three-step concussion protocol called “Concussion Check” for parents and coaches to determine if athletes should return to play: first, recognize the signs of a concussion and remove the injured athlete; second, assess their memory; and finally, conduct the King-Devick eye movement test. Mayo Clinic also helped to develop a King-Devick Test mobile app that complements the three-step protocol. Please read contributor Hannah Kennicott’s blog post for more information on how to implement the protocol and the accuracy of the King-Devick Test.
A recent study, by Shellie Acocello et al., has found that for NCAA Division 1 football players, a history of concussion increases the risk of sustaining a core or lower-extremity injury, even if they were free of concussion symptoms. In the study, the players who reported having had a concussion prior to the season were “twice as likely to sustain an injury” compared to players who did not have prior concussion history. Acocello suggests that the tests used for determining when an athlete has recovered from a concussion aren’t sensitive enough. Although neurocognitive function, coordination, and balance usually improve in seven to ten days, subtle perceptual and motor control deficits may last far longer, and it is these deficits that could be the cause of the additional injuries. The study was presented at the National Athletic Trainers' Association (NATA) 70th Clinical Symposia & AT Expo in June.
High Times news outlet recently highlighted the $9 million donation to be split between Harvard and MIT by alumnus Charles R. Broderick in support of cannabis research. Broderick hopes “to fill the research void that currently exists in the science of cannabis” and notably help understand how marijuana affects and possibly benefits brain health.
Another study, this time on high school and college football players, has suggested that biomarkers in the blood may be of use in determining recovery time after a concussion. The study by authors Morgan E. Nitta et al., and published in Neurology, looked at levels of seven biomarkers for inflammation that have been previously related to more severe brain injury. Two of the seven were elevated in concussed individuals at six hours after the injury compared to their non-concussed counterparts. Additionally, athletes with higher levels of interleukin 6 six hours after the injury were more likely to take longer to recover from their symptoms. The biomarker could potentially be utilized in the future to determine if an individual is concussed and how long their recovery may take.
Research on light therapy (photobiomodulation) by Margaret Naeser, PhD at the Boston VA Medical Center and Boston University School of Medicine has expanded to encompass preliminary but compelling research into the possible treatment of chronic traumatic encephalopathy, or CTE.
The case studies, presented at the International Brain Injury Association meeting in March 2019, in Toronto, on two retired, professional football players is the first research to show measurable increases in not only mood, sleep, and memory but also in fMRI brain scans showing increased “functional connectivity” between specific areas of brain cortex, in the first football player treated. The second football player did not choose to have fMRI scans performed.
This is the first brain-imaging evidence for suggesting a possible therapy for CTE, but much more research is needed. The use of photobiomodulation for the brain, using near-infrared LED devices worn on the head and clipped into a nostril, is still undergoing research to evaluate its full usefulness and efficacy. The first football player who participated later used in-home LED treatment with the Vielight Gamma, which fits within the FDA category of Low-Risk Devices, General Wellness; and no medical claims are made in this category. In full disclosure, the Vielight company funds some of Dr. Naeser’s LED research with TBI at the Boston VA Medical Center. For more information, read our in-depth report Light Therapy for CTE and our treatment page Light Therapy.
Cognitive behavioral therapy for insomnia
As reported on eCounseling by Shirley Amy, the integrated technology “Circady” by Healios has been nominated for the MedTech Breakthrough Award. Circady is a program that gives individuals struggling with major depressive disorder, TBI, and PTSD symptoms access to cognitive behavioral therapy for insomnia. Circady also provides a mobile app called the “Circady Sleep Diary App,” which allows users to track their sleep patterns and record the daily events that may disturb their sleep.
Vestibular dysfunction, the impairment of the inner ear that is related to balance, is often one consequence of TBI. Recent work published in Military Medicine by Megan C. Loftin et al. looked at vestibular dysfunction and rehabilitation in military populations. The research team, based out of Fort Carson, Colorado, implemented a three-month rehabilitation intervention for those suffering from vestibular dysfunction symptoms, such as dizziness. After 25 sessions, patient satisfaction and provider confidence to run the series of exercises were 100%. With both patients and providers finding the therapy to be effective, the potential for future vestibular rehabilitation programs appears promising.
A study found that 1 in 5 people who experience a mild traumatic brain injury (mTBI) may develop mental health symptoms up to six months after the injury. The authors Murray B. Stein, M.D., M.P.H. et al., studied 1,155 people who suffered a concussion and were treated in the emergency department. The patients who experienced an mTBI had a 21.2% rate of mental health symptoms at six months after the injury compared to orthopedic patients with 8.7%. The researchers found that “lower levels of education, self-identifying as African-American, and having a history of mental illness” increased the level of risk for mental health symptoms. There was also an increased risk for PTSD if the mTBI was from an assault. Dr. Stein is advocating for follow-up care for mTBI, especially for patients with additional risk factors. The study was published in JAMA Psychiatry.
A recent study published in The Journal of Speech, Language, and Hearing Research by Kathy R. Vander Werff et al. found that those with chronic post-concussion symptoms were more likely to experience long-term central auditory dysfunction than a control group. The American Speech-Language-Hearing Association characterizes central auditory dysfunction by the following symptoms: difficulty localizing sound, taking longer to respond in oral communication situations, frequent requests for repetitions, and many others. The researchers also found that in the mTBI group, auditory dysfunction was more prevalent than cognitive dysfunction.
The Journal of Head Trauma Rehabilitation published the largest-scale study on concussions ever undertaken in Canada. The researchers found that concussion rates were nearly twice as high as recorded in previous years. While this may seem to signal a concussion “epidemic” with 1.2% of Ontarians diagnosed with the injury, lead author Laura Langer BSc (Hon) states that their research spanning a larger sample size likely gives a more accurate picture of the current situation. The considerably high results are therefore likely due to the research that did not limit patient data to specific groups or single reporting sources, but also due to growing awareness and recognition of concussions.
Though the scooters that are zipping around many US cities may seem trendy and fun, it has been found that the popularization of motorized scooters is related to the rise of craniofacial injuries. Between 2008 and 2017, the incidence of craniofacial injuries as a result of scooter use tripled. The analysis, published in the American Journal of Otolaryngology by Amishav Y. Bresler et al., cautions the public to be aware of the risks and safety measures that can be taken to prevent injury. Safer America published their three best electric scooter safety tips: only allow one person per scooter, wear a helmet, and ensure that the scooter’s brakes, tire throttles, and lights are working properly before riding.
Since Kelley O’Hara of the U.S. Women’s Soccer Team sustained a head injury during the World Cup and immediately reentered the game, the concussion protocols for soccer have been called into question once again. As discussed by contributor Micalie Hunt in a blog post about head injuries in women’s soccer, the concussion rate in women’s soccer equals or exceeds the concussion rate in men's football according to several high school and college studies. Despite this high frequency and the fact that concussion symptoms present differently in women than in men, very few studies on concussions examine data sex-specifically. Be sure to read the blog post for more information.
Concussion Alliance co-founder Malayka Gormally