April 18, 2019 Newsletter
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A study by McCart M, et al., published in the journal Disability and Rehabilitation, found positive effects of an online course designed to teach educators how to work effectively with students who have had a traumatic brain injury. In the Classroom after Concussion: Best Practices for Student Success was developed by The Center on Brain Injury Research and Training (CBIRT). The study notes that "Without training in TBI, educators will be poorly prepared to monitor students' post-injury challenges and to address learning and behavioral challenges as they occur."
We highly recommended the University of Calgary MOOC (massive online open course): Concussion: Prevention, Management, and Treatment. The course features many experts in the field; for example, a video presentation on “The Biology of a Concussion” by Christopher Giza, M.D, Professor of Pediatric Neurology and Neurosurgery at UCLA. The seven-week course is free, and a certificate is available upon completion; registration is open until May 6th.
A study found that a majority of U.S. parents "support age restrictions for tackling in youth football." Hockey has age restrictions for body checking, and soccer has age restrictions for heading, but youth football has no age restrictions for tackling. Of the 1025 parents surveyed, "the majority (61%) supported age restrictions for tackling, and an additional 24% indicated they maybe would support age restrictions." The study, authored by Sara P.D. Chrisman et al., was published in the journal Pediatrics.
The failure of FIFA (professional soccer's international governing body) to institute temporary concussion substitutes puts players at risk for second impact syndrome and puts Fifa at risk for "substantial compensation claim from injured players" according to an article in The Telegraph. Other contact sports allow teams to put in a temporary substitute player while the injured player gets a 10-minute off-field concussion assessment. With the FIFA protocol, the player is only allowed a three-minute on-field concussion assessment, and the team plays down a player during that period.
The U.S. Quidditch Cup championship took place last weekend, but the sport appears to be less than magical in terms of concussions. A 2017 study by Rachel Pennington et al., published in the International Journal of Sports Physical Therapy, found that concussions were the most common injury in quidditch, at 21.5% of all injuries. Overall, the risk of injury is lower in Quidditch than other contact sports, but of those injuries "concussion seems to be over-represented in the sport of quidditch...[and] more females sustained concussion compared with males."
Emilia Clarke, who plays Daenerys Targaryen (Mother of Dragons) on Game of Thrones, has founded the charity SameYou.org. Working with partners in the U.K. and the U.S., her goal is to raise funds and increase access to neuro-rehabilitation after brain injury and stroke. In an essay in The New Yorker, Clarke describes suffering a life-threatening brain aneurysm and surgery at age 24 after filming the first season, and another cerebral aneurysm a year later. You can also listen to Clarke share her story on The New Yorker Radio Hour.
An article published in Counseling and Psychotherapy Research by Kevin E. Kip et al. reports on Accelerated Resolution Therapy (ART) and its effectiveness with a group of U.S. service members with PTSD and mild traumatic brain injury. ART "appears to provide frequent clinical relief of symptoms of PTSD in an average of four sessions among military personnel with challenging clinical presentations, including concomitant TBI and extensive operational combat‐related trauma." ART treatment "employs a series of horizontal eye movements to enable clients to effectively rewrite troubling memories."
The FDA published a safety communication warning the public not to use apps or medical devices that "claim to help assess, diagnose or manage" concussions. An FDA press release clarified that there are currently no devices to aid in assessing concussion that should be used by consumers on their own." The concern is that these unapproved apps/devices may produce a "no injury" assessment which could lead to "a person with a serious head injury returning to their normal activities instead of getting medical care." For reference, see the FDA list of approved devices to diagnose concussions.
A study by Acly R Torres et al., published in the journal Cureus, found that an MRI is not an effective diagnostic tool for children with concussions and persistent symptoms and that "based on these results we recommend that clinicians should avoid ordering MRI studies in this group."
Researchers have made a step towards diagnosing CTE in living patients. They used PET scans to measure tau and amyloid-beta proteins in the brains of former NFL players; one group had cognitive and neuropsychiatric symptoms, and the control group did not have these symptoms. The study by Robert A. Stern, Ph.D. et al., published in The England Journal of Medicine, found that the group "with cognitive and neuropsychiatric symptoms had higher tau levels [compared to the control group] in brain regions that are affected by CTE."
Intimate Partner Violence
A bill in the Washington State legislature to "improve statewide response to traumatic brain injuries suffered by domestic violence survivors" has passed the Senate and House chambers. According to an article in The Daily Evergreen, the law will "require health services and law enforcement to recognize probable TBIs in abuse victims." Also included in the bill: development of handouts which explain that domestic abuse can lead to brain injury; a self-screening tool for symptoms; and additional TBI resources.
Work / Employment
A Danish study researched how patients' employment was affected after a concussion, noting that "sickness absence after mild traumatic brain injury (mTBI) is frequent due to postconcussive symptoms." The research found that five years after a concussion, "43% of concussed patients were not attending ordinary work" and they were "receiving health and social transfer benefits." A Danish social transfer benefit is a cash benefit if a citizen has "undergone a significant change in their social circumstances" which is related to the at-risk-of-poverty rate. The study concludes: "that mTBI has a long-term impact on labor market attachment," meaning employment or trying to find employment. The study by Heidi Jeannet Graff et al. was published in the journal BMJ Open.
A new study concludes that a return-to-drive determination for "adolescents recovering from a [sports-related concussion] should be a core component of a physician's assessment." The study published in the Journal of Pediatrics by James MacDonald, MD, MPH, et al., found that computerized neurocognitive testing (CNT) may help physicians make the return-to-drive decision. They found that the "odds of being fully cleared to drive were 5.9-fold greater among patients who were administered CNT."