Dancing helps TBI recovery (8/15/19 newsletter)

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We are pleased to have Carleton College students and alumni interning with Concussion Alliance. Intern contributors this week:

Editor: Galen Moller
Contributors: Eloïse Cowan, Hannah Kennicott, and Julian Szieff.


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Education

Prominent concussion experts give free concussion conference

Prominent concussion experts Dr. John Leddy, Dr. Mark Herceg, and Dr. Rosanna Sabini will head up a free conference on concussion for parents, coaches, school administrators, athletic trainers, healthcare professionals, and youth athletes. One of the conference topics will be “the important role of exercise and active rehabilitation post-injury,” an aspect of the recovery process which Dr. Leddy has developed with his groundbreaking research. The conference will be at the Westchester County Center in White Plains, New York, on Thursday, August 29th, 6-8:30 pm.

Sports

Duration of time before NFL players return to play is increasing

Newswise covered the recent study by Dr. Toufic R. Jildeh et al. which found that on average, NFL players return to play 19 days after their concussion, which is almost double the duration of two decades ago. They also found that a high number of wide receivers and running backs were able to return to play after a concussion and perform well both in the long-term and short-term. The study was published in The American Journal of Sports Medicine.

Cannabis

Cannabis (and in particular THC) reduces pain, including headache pain

Pain is a frequent symptom of concussion, particularly headache pain. A study, published in Complementary Therapies in Medicine, looked at self-directed use of medical marijuana for pain and found that the average cannabis user experiences pain reduction of 3.1 points on a 0-10 scale. The researchers used the largest database of its kind in the United States, with 20,000 cannabis user sessions providing real-time responses via the Realeaf app. Momentary pain intensity levels were divided into five pain categories: musculoskeletal, gastrointestinal, nerve, headache-related, or non-specified pain.

Xiaoxue Li et al. found that dried whole cannabis flower was associated with greater pain relief than other cannabis products, presumably products such as tinctures, edibles, and vape products. Tetrahydrocannabinol (THC) showed the strongest pain-relieving effect for all five categories of pain. Cannabidiol (CBD) was only associated with relief for gastrointestinal and non-specified pain.

Diagnostics

Brightlamp introduces groundbreaking concussion diagnosis app for iPhones

(This paragraph is based on a press release). Doctors often test for concussions by shining a light on the eye to measure the pupil’s reactivity. The Brightlamp company’s new app, Reflex, allows companies and doctors to perform and record this test using the iPhone camera. This makes the test objective, fast, and very accurate with the outcomes of the exam being graphed and recorded. Introducing technology like this into healthcare promises to make the field quicker, more accurate, better-coordinated.

Therapies

Cranial therapy found to be a safe treatment for persistent post-concussion symptoms

A small pilot study found that osteopathic cranial manipulative medicine (OCMM) is a safe treatment for those who are also receiving conventional treatment for persistent post-concussion symptoms. Each patient received one session of OCMM, which was applied until cranial restrictions were normalized; the sessions were less than 30 minutes. Komal G. Patel et al. found that the nine patients who received osteopathic cranial manipulation reported no adverse effects during or immediately after the treatment.

Additionally, five of the seven patients who returned for follow-up showed improvement in their overall symptoms, based on their scores on the Post-Concussion Symptoms Scale. The study was published in The Journal of the American Osteopathic Association. For more information, see our article on Craniosacral Therapy.


Veterans

‘Dancing Well’ Program helps veterans with community reintegration

Veterans with PTSD and TBI saw improvements in their wellness scores after participating in “Dancing Well,” a 10-week community barn dance program. Robin Gustafson et al. aimed to alleviate the persistent social isolation and anxiety that occurs within the veteran population, and they turned to a community dance program run by dance educator Deborah Denenfeld.

Community dance has the benefits of increased social and family connections, as well as physical exercise, which is known to help reduce stress and increase cognitive plasticity. The comparison from the psychological testing (measuring connectedness, isolation, and optimism) found substantial increases after ten weeks of involvement in the program which leads to hope that a community-building focus for PTSD and TBI recover can aid veterans in their reintegration. The study was published in the Journal of Veterans Studies.

Mental Health

Cognitive-behavioral therapy shows positive results for post-concussion syndrome

A review of the management of pediatric post-concussion syndrome found that cognitive-behavioral therapy (CBT) has “consistently positive results in post-concussion syndrome (PCS).” Several research studies have found that youth and adolescents given CBT compared to standard care for PCS had improved outcomes: increased ability to tolerate exercise, reduction in physical symptoms, and decreased psychological distress.

The authors Mitul Kapadia et al. explain that “injured youths often engage in catastrophic thoughts such as, ‘I’m broken, I’ll never get better.’” The fears are part of an interactive cycle: fears can trigger psychological distress; which stimulates the “fight-or-flight” response; which results in physical symptoms such as light-headedness, dizziness, and headaches; which then trigger and worsen existing PCS symptoms. CBT can interrupt this cycle, and although there is no uniform CBT treatment protocol for PCS, strategies can include reassurance (about the prognosis), relaxation strategies, mindfulness, biofeedback, cognitive restructuring, and more. The study was published in Current Reviews in Musculoskeletal Medicine.

Statistics

The impact of repeated sub-concussive hits on the midbrain

A new study researching structural changes in the brain from a season of college football conducted by Adnan Hirad, PhD, at the University Rochester Medical Center has found significant structural changes to the brain using helmet sensors and MRI techniques. Even though only 2 of the 38 subjects had been diagnosed with a concussion, in just one year all players showed a clinically significant decrease in midbrain neuron integrity, meaning the cells membranes became leakier--possibly due to swelling.

This decreased integrity is linked to the symptoms of concussion (visual, auditory, and balance problems) because these traits are based on brain structures in this area.

Additionally, while the number of hits in a season predicted some of the damage, rotational acceleration (from twists of the head) was associated with more damage to the midbrain. The fact that rotational acceleration in particular causes damage is likely because the midbrain is the part of the brain most held in place by the brainstem and the skull while the cortex above it is freer to move.

The good news is that the authors of this study hope to use the midbrain as an indicator of risk and a diagnostic tool for players and people with traumatic brain injury. This study, published in Science Advances, is crucial to expanding our knowledge of the brain’s reaction to impacts as well as our ability to diagnose brain damage and our ability to make sports safer.

Women's Health

1.6 million U.S. women affected by TBIs from partner violence

Researcher Eve Valera sheds light on brain injuries in women
The New York Times recently highlighted the work of Eve Valera, Ph.D., who investigated domestic violence induced brain trauma in women in 2003 when the National Football League had just begun to investigate brain injuries in players. She realized that half the women interviewed had endured multiple mild traumatic brain injuries (mTBI) and at least one-third of traumatic brain injuries (TBI).

In a recent study published in the Journal of Neurotrauma, she used her samples to estimate that 1.6 million U.S. women are affected by TBIs from partner violence. However, knowledge about mTBIs has primarily been found from research with male athletes, leaving a lack of understanding of how brain injury affects a substantial population of women.

Valera, herself, struggles with recognition and funding for her research on domestic violence victims due to the prominence of studies on football players. She hopes to push for research representative of the general population and raise awareness of the lack of diagnosis affecting intimate partner violence victims.

Culture

American Ninja Warrior competitor suffers from long term concussion symptoms

According to 1011 Now, American Ninja Warrior contestant Maggi Thorne has spent the past two months in rehabilitation after suffering a concussion on the show. The five-season competitor injured herself during the course for the July 29th episode though she completed the race before being taken to the ER. Thorne, struggling with balance and cognitive learning challenges, states, “I'm not the person who I was before ninja warrior, but I know I will be again.”

Transportation

Electric scooters, environmentally-friendly innovation or public nuisance?

An article from NBC News’ THINK discusses the danger of the highly popular electric scooters in cities throughout the U.S. While the satirical tone immediately establishes the scooters as dispensable entertainment, Moya-Smith also highlights recent deaths and over 1,500 injuries that occurred since their distribution. A clear lack of safety regulations has contributed to the problem, which has grown to a significant political, economic, and social scale, displaying the pressing need for political measures to limit the ongoing injuries and destruction.

CTE and Neurodegeneration

Number of years playing football correlated with dementia-associated factors

JAMA Neurology recently published the work of Dr. Michael L. Alosco et al., which examined the brains of 180 deceased individuals who played football and were diagnosed with any disease that affected their brains’ structure or function. They found a correlation between the number of years playing football and the severity of conditions associated with dementia. These conditions included white matter rarefaction, which is the lessening of the density of the tissue, and neurofibrillary tangles in the dorsolateral frontal cortex.

Helmets / Mouthguards

Release of smart mouthguards by Impression Healthcare

Impression Healthcare has agreed to collaborate with Force Impact Technologies to sell FitGuard smart mouthguards. These mouthguards measure cranial acceleration and can determine impact severity while connected to an app via Bluetooth. The mouthguards are to be distributed throughout Australia, New Zealand, and Hong Kong, with the aim of protecting contact sports participants from the consequences of brain injuries.

In the U.S., however, the FDA has published a safety communication warning the public not to use apps or medical devices that “claim to help assess, diagnose, or manage concussions.” See our April 18th newsletter.


Executive Editor


Concussion Alliance co-founder Malayka Gormally