Sleep quality can predict concussion recovery (8/1/19 newsletter)

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

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

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Concussion Alliance is Now Partnering with Teaching for Concussion Education Efforts

Concussion Alliance is now partnering with TeachAids to further our mutual concussion education efforts.
The Northwest Brain Injury Symposium (NWBIS) reached out to Concussion Alliance for educational materials for their conference in Spokane earlier this month. We were pleased to provide NWBIS with TeachAid’s CrashCourse film, which was presented before the panel discussion. Read more about the NWBIS conference in this blog post.


Video Review Shows FIFA falling behind in concussion care

Researchers from St. Michael’s Hospital in Ontario reviewed a video from the 2016 UEFA soccer tournament in Europe to assess if concussion protocols were properly followed. The study, by Karan Joshua Abraham et al., was published in BMJ Open.

In the 51 games they investigated, they found 69 Potential Concussive Events (PCE). These were determined by six observable signs of concussion: “slow to get up (defined as a duration of 5 or more seconds following impact), clutching of the head, disorientation, loss of consciousness, seizure-like behavior and signs of obvious disequilibrium.” Of these events, 48 (69.6%) PCEs showed two observable signs of concussion. However, only 19 (27.5%) of all events resulted in medical examination by sideline healthcare professionals, and all players returned to the field of play whether examined or not.

This is not in line with the fifth International Conferences on Concussion in Sport 2016, which FIFA agreed to follow. It states that any sign of concussion should be removed from play and assessed using a standardized test called the SCAT3. While it is impossible to know what the players would have scored on these tests, the lack of removal from play and haste in return to play endangers players and is the latest in a series of events which epitomize FIFA’s poor track record with concussion management.


Cannabinoids inside and outside the body, and their effect on wellness

Cannabinoids are a class of molecules including CBD and THC and many others. Many of them occur naturally in the body as well as in the cannabis plant. In an interview with Dr. Greg Gerdeman PhD, Project CBD discussed how cannabinoids are involved with critical systems in the human body, including inflammation, exercise, eating, and brain growth. For example, anandamide is an endocannabinoid naturally elevated during endurance exercise and associated with the “runners high," but a sudden drop in anandamide is implicated with the fear or flight response. Additionally, other endocannabinoids are released by glial cells (support cells surrounding neurons in the brain) to modulate neuroplasticity, which is crucial for brain injury recovery.

Gerdeman also stresses how pervasive the endocannabinoids system is in the human body--it is found places such as in the brain centers for fear and pleasure, the stomach, and the fat tissue of the body. This pervasiveness means there is tremendous potential for wellness and resilience with cannabinoids. It should be noted for conflicts of interests that Greg Gerdeman recently retired from teaching about the endocannabinoid system at Eckerd College to become the chief science officer with 3 Boys Farm, a medical marijuana company in Florida.


Hearing Deficits are Common After a Concussion

A study by Renata M. Knoll MD et al. found that compared to a control group, hearing deficits and tinnitus, and their associated handicaps, were common in concussion patients. The group of concussion patients in the study had been prescreened, so none of them had a blast-related TBI or had occupational noise exposure. The study was published in Laryngoscope.


A Visual Exercise Program Significantly Improves Cognitive Function

In four patients with traumatic brain injuries, a computer-based program of visual timing exercises significantly improved cognitive function. After 12 weeks of daily 10-minute exercise sessions, the patients showed significant improvements in reading fluency, attention, and memory. Magnetoencephalography (MEG) brain scans and clinical tests confirmed these improvements in brain functioning. According to an article in JDSupra, “The working hypothesis was that a TBI causes visual timing deficits that in turn disrupt processing at higher levels, causing deficits in attention and executive control.” The study, by Teri Lawton et al., was published in Restorative Neurology and Neuroscience, and was so promising that UC SanDiego Health is planning a larger clinical trial study. The researchers will be accepting patients sometime in the future, in San Diego and other locations.

If you want to try this yourself, you can purchase the same program the researchers used. The Path to Reading computer program has 96 training sessions. Each training session is ten minutes, and the user should do one session six days a week, for 12 weeks. The software only works on Windows operating systems for the time being. According to the website, the price is normally $1,995, but the summer discounted price is $676. They also offer a free one-week trial, which includes the first six sessions. You can watch a video demonstration here.


Patients’ Resilience Correlated with Better mTBI Outcomes

Stars and Stripes Korea reports that researchers at the Defense and Veterans Brain Injury Center have found a correlation between military servicemembers’ resilience and better mTBI outcomes. Those with more optimistic attitudes were less likely to report mTBI symptoms﹣an interesting psychological component to consider when treating mTBIs. The study, by Dr. Matthew W. Reid et al., was published in the Journal of Neurotrauma.

Mental Health

How PTSD, Depression, and Sleep Affect Recovery from Concussion

A study by Lisa H. Lu et al. researched how sleep problems, PTSD, and major depressive disorder (MDD), contributed to post-concussion symptoms (PCS), and whether sleep problems alone could contribute to PCS. They found that for active duty service members with a history of mTBI and PTSD, PTSD contributed more significantly to their PCS. But for members without a history of PTSD or MDD, sleep problems alone could contribute to PCS. The study was published in NeuroRehabilitation.


Insomnia as a Predictor of More Severe Adolescent Concussion

A new study from the University of Washington Center for Child Health found insomnia symptoms were associated with worse post-concussion symptoms at three weeks and three months. The study surveyed 29 patients, whose mean age was 14 years old. While only 12% of these patients still had severe symptoms at three weeks, greater insomnia symptoms predicted more severe post-concussion symptoms. Sleep duration and other sleep symptoms were not predictors. This study establishes that insomnia may provide an area of focus for more in-depth intervention/follow up for medical professionals to focus on in adolescents and potentially other age groups. The study, by See Wan Tham et al., was published in Brain Injury.

Women's Health

Differences Between Men and Women for Community Integration with mTBI

A study by Mollayeva et al., published in the journal Concussion, looked more deeply into the noted differences between the experiences of men and women with mTBI, and how these differences affect community integration. They found that women were more likely than men to be seen as exaggerating or making up their symptoms, which was associated with worse community integration. The men in the study were more likely to live alone and/or report family problems; living alone was associated with better community integration. The study argues that the differences between these experiences call for different approaches to managing mTBI in men and women.


New California Legal-Medial TBI Nonprofit

The Business Wire reported on the Brain Society of California, a new nonprofit that focuses on TBI awareness and education both from medical and legal angles. The society, nicknamed Brain SoCal, was founded by TBI attorney Tina Odjaghian and is made up of prominent California lawyers. Brain SoCal will host an annual medical-legal conference, the first of which will be in Los Angeles in two months.


Denver Woman sustains TBI from Electric Scooter Accident

Boulder restaurant manager Caitlin Jacobsen was on an electric scooter in Denver when the handlebars caught the side of a fence and the scooter flipped. She sustained a TBI and experienced partial paralysis as well as difficulty talking. Her family plans to speak to the City Council in Boulder, where Jacobsen resides, to request that the city’s current ban on electric scooters be extended. The story was covered by CBS4.

Executive Editor

Concussion Alliance co-founder Malayka Gormally