This week our exciting news is in the Conference Presentation category, and our lead article, Adverse effects of soccer heading found in the same location as CTE pathology, is in the Sports category.

In this newsletter: Opportunities, Sports, Self-Care, Therapies & Diagnostic Tools Under Research, and Conference Presentation.

We appreciate the Concussion Alliance volunteers and staff who created this edition:
Writers: Zoe Heart, Esmeralda Garcia-Ramirez, and Josh Wu.

Editors: Malayka Gormally and Conor Gormally

Do you find the Concussion Update helpful? If so, forward this to a friend and suggest they subscribe.

Opportunities

Wednesday, December 18, 8 am PST: A free webinar, 2024: Sports Concussion Update, will be presented by Ryan L. Rockwood and hosted by the Center on Brain Injury Research and Training. Register in advance.

Tuesday, December 17, 6 pm EST: A free webinar, Return to Work, Vocational Rehabilitation and Occupational Therapy, presented by Leslie Birkett, OT. (Occupational Therapist) and hosted by the Canadian Concussion Centre. Register in advance.

Enrollment is now open for two kinds of free, interactive, online 6-week programs from Love Your Brain. Join a Zoom call for either Group Discussions (45 min classes with group discussion) or Yoga and Discussion (75 min classes with gentle yoga & group discussion.) Each program comes with weekly emails with four mindfulness tools, as well as specialized programs for BIPOC, Veterans, LGBTQIA+, and more. The programs begin in January.

Call for study participants: military veterans who have had concussions and/or a traumatic brain injury, including any injury to your head or neck that caused you to lose consciousness or feel dazed/confused/experience a gap in memory. Read our blog post for more information on the Late Effects of TBI (LETBI) study. If you are interested, please contact Julia Kirschenbaum at julia.kirschenbaum@mountsinai.org, call us at 212-241-5152, or sign up online.

Sports

Adverse effects of soccer heading found in the same location as CTE pathology

A study found a link between soccer players with “a higher level of heading” and brain abnormalities in regions where Chronic Traumatic Encephalopathy (CTE) pathology is most often found. Columbia University professor Michael Lipton presented the as-yet-unpublished study at the annual meeting of the Radiological Society, which was announced in a press release. Through a new imaging technique called diffusion MRI, researchers were able to compare the brains of 352 soccer players and 77 non-collision-sport athletes, finding white matter differences in the frontal lobe, an area frequently impacted by heading, in those soccer players doing a high level of heading.

Furthermore, as discussed in a Newsweek article by Sean Duke, Lipton’s team found an association between more repetitive head impacts with poorer verbal memory, poorer verbal learning, and worse cognitive performance. This association suggests a “causal link between heading and worse brain function.” Soccer players who did a high level of heading were found to have brain microstructure abnormalities “at the depths of crevices in the brain surface called sulci." Lipton explains that "The abnormalities occur in the locations most characteristic of CTE, are associated with worse ability to learn a cognitive task and could affect function in the future."

Participants were male and female athletes aged 18-53. In the soccer players who reported frequent heading of the ball, Lipton reported a high level of abnormality in the white matter of the frontal lobe––a region frequently impacted by soccer heading––and particularly the “white matter adjacent to sulci, which are deep grooves in the brain’s surface.”

Notably, few of the soccer players studied had reported a history of diagnosed concussion, illuminating the “delayed adverse effects” of repetitive head impacts, including those that do not trigger concussion symptoms.

Based on current evidence, some level of soccer heading may not lead to the frontal lobe changes found in the study, but the threshold is unknown and will likely vary for each person. But, critically, “If heading is associated with imbalance, nausea, persistent headache, disorientation or trouble functioning, Lipton advised caution, rest and perhaps medical assessment.”

Self-Care

Meditation techniques associated with lower cortisol levels for at-risk populations

A recent meta-analysis by Adam Koncz et al. suggests that different meditation interventions (particularly those focused on mindfulness) benefit individuals at risk for high cortisol levels––especially for those with a somatic (physical) illness. (While this meta-analysis is not studying concussion, we think it may be relevant to concussion recovery.) The study, published in Health Psychology Review, explains that higher cortisol levels are associated with various mental disorders, somatic illnesses, and chronic stress. Prolonged high cortisol levels can adversely impact the cardiovascular and immune systems.

The meta-analysis found that partaking in mediation techniques consistently shows a “significant, medium-sized reduction” in cortisol levels for at-risk populations and a “moderate-sized benefit” effect for those living in stressful situations. They found only a “marginally significant, small effect” for no-risk groups, but the finding is considered preliminary due to the small number of control groups. They also found no effect on those with a mental illness––but this result contrasts with other findings that meditation is beneficial for anxiety and depression. Overall, this meta-analysis suggests that meditation may be effective for at-risk populations; the authors note that “Preliminary results suggest that benefits of meditation interventions might not fade with time.”

The meta-analysis reviewed 34 randomized control studies that compared mediation for populations at risk for elevated cortisol levels to control groups. The at-risk populations in these studies included somatic illness (cancer, diabetes, etc.), mental illness (PTSD, depression, etc.), or those living in stressful life circumstances (low socioeconomic status, etc.) These studies involved cortisol sampling procedures such as saliva, blood, urine samples, and hair cortisol.

Cortisol is a hormone produced in response to stress and regulated by the hypothalamic-pituitary-adrenal (HPA) axis. Our cortisol levels remain low daily but increase in response to stress. To explore the relationship between meditation and cortisol levels, researchers conducted a systematic search of several databases, including Web of Science (Core Collection), EBSCO (PsychInfo, PsychArticles, MEDLINE), PubMed, and ProQuest. The meta-analysis covers a variety of meditation techniques that can be categorized into focused attention techniques, open monitoring techniques, transcendental meditation, and mind-body techniques.

However, in contrast to previous studies, the theory that anxiety and depression can be decreased with mindfulness meditation could not be proven with these studies that sample cortisol levels. Regardless, various meditation programs can be helpful for those in life situations that may cause an increase in cortisol levels. Longer meditation programs (those that involve more than 20 hours) were found to be more effective for stress reduction.

Therapies & Diagnostic Tools Under Research

Photobiomodulation improves neuromuscular deficits related to concussions and repetitive head impacts

A new clinical study conducted by David Tate et al. at the University of Utah looked at the relationship between photobiomodulation (PBM) and neuromuscular control, specifically targeting patients with concussions or repetitive head acceleration events (RHAEs). The physiological aftermath of concussions or RHAEs is linked to subtle yet cumulative brain abnormalities that impair motor control, balance, and reaction time.

The authors of the study, published in Photobiomodulation, Photomedicine, and Laser Surgery, hypothesized that using red or near-infrared light intranasal and transcranial PBM (itPBM) can alleviate these neuromuscular deficits. After following an 8-week protocol using the Vielight Neuro Gamma device, participants exhibited significant improvements in reaction time, balance scores, and grip strength for both hands. Vielight produced a 7-minute video that explains the study and results.

In the study, 43 participants (aged 18-69) performed a baseline assessment consisting of reaction time, grip strength, dexterity (Grooved Pegboard Test), and balance (measured by MiniBEST). Afterward, participants self-administered itPBM using a headset with light-emitting diodes (the Vielight Neuro Gamma) targeting cortical and nasal regions over an eight-week period. The protocol involved 20-minute treatments every other day.

While the mechanism for the improvements is not known, the researchers proposed three non-exclusive possibilities for how itPBM affected neuromuscular control: The light improves circulation, repairs mitochondrial damage, or reduces inflammatory processes. PBM is still an emerging field in neuroscience, so more research must be conducted before mass adoption of this therapeutic.

While the study published promising results, some limitations of the study were the small and predominantly male sample. Also, the participants self-administered their treatment, which created the possibility of variability in treatment procedures. Other daily habits like exercise and nutrition were not controlled for. While this study only looked at physical measures of neuromuscular control, future studies should corroborate the results with corresponding improvements in neural activity or health in the brain.

Presenting at the World Congress on Brain Injury

Concussion Alliance will be presenting a poster on our resource for concussion patients with pre-existing disabilities

Concussion Alliance has been invited to present a poster at the 15th World Congress on Brain Injury in Montreal, Canada, next March! The poster (and related abstract) focuses on our resource page, Individuals with a Pre-Existing Disability, which is part of our series of “Communities” resources for different populations. The biannual World Congress on Brain Injury is attended by ~1,000 researchers and clinicians from around the world. We last presented a poster at the 14th World Congress on Brain Injury in Dublin, Ireland, and we are honored by the return invitation.

The invitation is based on an abstract authored by Concussion Alliance in collaboration with Osman Ahmed––a researcher, physiotherapist for the Football Association’s elite disability squads, co-chair of the Concussion in Para Sport Group, and Concussion Alliance Advisory Board Member. Concussion Alliance also coauthored this abstract with Angela Romeo, a disability professional and community advocate.

The resource is intended to be a starting point to address the gap in knowledge, research, and healthcare practice affecting concussion patients with a pre-existing disability––offering unique resources to support concussion patients navigating the complex interaction of concussion recovery and their disability.

This resource presents a novel first step toward community-specific concussion resources for individuals with disabilities––athletes and non-athletes alike. The resource includes sections on identifying and treating concussions, persisting symptoms, mental health, disability stigma, and navigating healthcare, and a subsection for blind and visually impaired individuals.

The current iteration of the resource focuses on vision impairment, an area in need of urgent measures (Teodoro et al., 2024), but it is constructed to be broadly applicable to individuals with other disabilities. Concussion Alliance, Dr. Ahmed, and disabled advocates plan to continue to expand these resources in the future to include evidence-based, condition-specific resources for other disabilities.