This week, our lead article, Hyperbaric oxygen therapy (HBOT) alleviates chronic neurocognitive symptoms in adults who suffered from mild or moderate traumatic brain injury as children, is in the Treatments Currently Available category.

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In this newsletter: Opportunities, Concussion Advocate Training Workshop, What’s New with Us, Therapies Currently Available, Mental Health, & Youth

Writers: John Rosseel & Emily Sugg

Editors: Conor Gormally, Malayka Gormally, & Zoe Marquis

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

Opportunities

Friday, October 24th, 9 am to noon, PT: A free workshop, Brain Injury and Domestic Violence: Intersections, Impact and Support, hosted by The Center on Brain Injury Research and Training. Register in advance.

“Please note: Sessions will include discussion of topics such as domestic violence, trauma, and the justice system. We encourage participants to practice self-care, and resources will be available.”

Tuesday, October 28, 6 pm ET: A free webinar, Managing Symptoms of Dizziness and Imbalance Post Concussion, presented by Shaleen Sulway & Elizabeth Crawford, hosted by the Canadian Concussion Centre. Register in advance.

Tuesday, November 11, 6 pm ET: A free webinar, Concussion in Women, presented by Dr. Carmela Tartaglia, hosted by the Canadian Concussion Centre. Register in advance.

Tuesday, November 18, 7 pm ET: A free online session, Principles of Getting Back to School and Work, the first of three in an evening series for medical providers working with pediatric patients, hosted by University Health Network ECHO Medical Education. Register in advance.

Call for paid study participants: If your child has had a traumatic brain injury, including a concussion, in the past 1-12 months and is 8-16 years old, they may be eligible to join a remote study that can be done from home. Families receive compensation for their time and feedback on their child’s progress. Contact the study team at engagetbi@ucsf.edu or call/text (415) 993-1048 for more information.

In this UCSF study, your child plays a video game, then you and your child complete assessments and surveys to measure cognition. To learn more, see the flyer, visit this study page, or contact the study team, engagetbi@ucsf.edu or call/text (415) 993-1048.

Available now: A recording of last week’s webinar, Accumulating Concussive and Psychological Exposures, with a focus on the relationship between concussion, blast exposure, and PTSD in military populations. Presented by Dr. Lisa A. Brennar, hosted by the U-Michigan Concussion Center.

Concussion Advocate Training Workshop: a remote educational webinar (11/6)

Thursday, November 6th, 1-2 PM PST

Please join us for a free, one-hour Zoom workshop with Concussion Alliance Co-Founders Conor Gormally and Malayka Gormally. During this session, you will become a trained concussion advocate for your workplace, family, and community. You will learn about common causes of concussion, myths, and current evidence-based best practices for self-care and navigating the healthcare system. We’ll also show you how you can use our Navigating Your Recovery quick guide to help your community make sure they’re doing the right things in the initial days and weeks after a concussion– and who to go to if symptoms persist. There will be time for a Q&A.

Register in advance for this webinar:

https://us02web.zoom.us/webinar/register/WN_jwGwO5rTT-OCQsD4Of8yKg

After registering, you will receive a confirmation email containing information about joining the webinar.

New with Us: Concussion Alliance brings on new employee!

We are excited to announce that just over 3 weeks ago, Concussion Alliance has hired a third employee! Since our inception in 2018, Concussion Alliance has been primarily driven by its two co-founders. Our volunteers, interns, leadership team, and now board directors have made huge strides, but the day-to-day operations of the organization have largely been the responsibility of two people. As the organization has grown, it has become increasingly challenging to keep up with our workload.

This fall, thanks to our amazing community of Concussion Alliance supporters, we’ve secured funding to add a third employee to our staff; I'm delighted to welcome Zoe Marquis to Concussion Alliance! Zoe joined us on October 1st as our Program & Operations Associate. Zoe graduated from Carleton College this past spring and participated in our Summer 2024 Concussion Education & Advocacy Internship.

We’ve already seen some incredible change and progress in what we’re able to accomplish, and it feels great to have another person to work with on a day-to-day basis. Zoe is learning fast and settling in well, and we can’t wait to see how things continue to evolve going forward!

Therapies Currently Available

Hyperbaric oxygen therapy (HBOT) alleviates chronic neurocognitive symptoms in adults who suffered from mild or moderate traumatic brain injury as children

A study by Shlifer et al. found that hyperbaric oxygen therapy (HBOT) can alleviate cognitive symptoms associated with post-concussion syndrome (PCS) in adults who suffered from mild or moderate traumatic brain injury (TBI) and PCS as children and who are still dealing with persisting neurocognitive symptoms. Published by Frontiers in Neurology, the researchers studied 26 patients who were diagnosed with TBI and PCS before the age of 17, had only been diagnosed with that single brain injury, and did not have other, unrelated neurocognitive impairments.

Before and after receiving HBOT treatment, these patients were tested using computerized neurocognitive assessments to measure their cognitive abilities, including executive function, information processing speed, attention, memory, and motor skills (an online “catch game” with a cognitive aspect). The patients were given this test two months prior to HBOT and one month after their last session. The results showed improvements across all areas tested except for motor skills and were valid for both mild and moderate TBI. These findings held regardless of time elapsed after injury, with a mean of 23.6 years between participants’ injury and receiving HBOT, suggesting HBOT can treat PCS-related neurocognitive impairments even decades after injury. However, the study only evaluated these neurocognitive changes one month after HBOT, so understanding the duration of these improvements necessitates further study.

These patients received a standardized therapy procedure of 40 HBOT sessions––five per week––at 2 atmospheres of pressure and 100% oxygen for 90 minutes each. The higher pressure and 100% oxygen cause an increase in oxygen levels within the blood, triggering regenerative processes within the brain that manage inflammation, stimulate growth and repair of cells, and cause stem cells to migrate. The researchers argue that these beneficial neurological effects are why patients’ neurocognitive symptoms improved even years after their injury, due to the “[induced] neuroplasticity and recovery of dysfunctional brain regions.”

Shlifer et al. noted several limitations of their study, including its sample size. Since the researchers were highly selective (their exclusion criteria narrowed the participant pool to 26), they argue that the study lost generalizability; they encourage further research using a wider sample size. Patients also reported other health improvements, such as better sleep and mood. However, these were not formally evaluated and therefore not included in the final results. Finally, the study did not include a longer-term follow-up after the first month post-HBOT evaluation, meaning researchers could not determine for how long the patients’ alleviated symptoms continued.

Mental Health

Concussion patients ages 5-24 experience increased (but still low) suicide risk

An article in the American Journal of Preventive Medicine found that the risk of suicide in patients ages 5-24 increased after sustaining a concussion. Yang et al. used Ohio Medicaid claims from 41,341 concussion patients and 376,171 orthopedic injury (OI) patients who were monitored for up to ten years. The OI group was used as a control to monitor suicide rates and to account for potential bias in experiencing injury. Using death certificates, the team correlated participants’ injuries with a possible death by suicide. They found that 42 people died by suicide in the concussion patients group compared to the 229 in the OI group. Due to the differing sizes of the groups, this meant the concussion group had a suicide risk of around .084% compared with the OI group’s .050%, or a 60% increased risk of dying by suicide compared to controls with orthopedic injury.

Further, each subsequent concussion after the first was associated with a roughly 50% increased risk of suicide. These results persisted even when the researchers accounted for biases inherent in race, sex, age, and mental health. While these increased risks are considerable, the total suicide risk 5 years post-concussion was .034% higher than in the OI group, which would equate to 34 more people dying by suicide per 100,000 people with concussions. As the article notes, though “overall risk remains low” for those who have sustained concussions, targeted prevention strategies are crucial to protect those with increased susceptibility to suicide after their injury. Yang et al. suggest “early screening for suicide risk and mental health concerns, as well as integrated, collaborative care models to support recovery and reduce long-term risk– particularly for youth with repeated concussions”.

Yang et al. argue that, while the mechanisms connecting concussions and suicide are elusive, concussions can impact brain function (such as serotonin and dopamine production), which may lead to an increased risk of depression and anxiety. Concussions can also impair neurochemistry, metabolism, and cognition; impairments to cognition that may lead to poor judgment and decision-making, which, in developing brains, may raise susceptibility to suicidal thoughts. These factors, combined with increased isolation from school and sports due to recovery, contribute to the risk of suicide, anxiety, and depression. The team highlights that a pervasive misunderstanding of concussions is to blame for inaccurate rehabilitation and reporting. They argue that caregivers may assume concussions go away quickly and won’t impact life after recovery. Instead, Yang et al. state, “These findings support the view of TBI as a chronic health condition with long-term consequences…”

This article, while strengthened by its large and diverse concussion and control groups, has key limitations. Data was collected from a single state, Ohio, and a single insurance provider, Medicaid, which may introduce social biases that may not be present in other samples. Furthermore, patients in the concussion group were not diagnosed with a standardized assessment. Rather, the diagnostic criteria and assessment procedures were at the discretion of the doctor who saw each patient. In turn, the specific clinical data surrounding diagnoses were unavailable– apart from the diagnosis itself. Further research is necessary to better understand the connection between concussion and suicidality in children and young adults.

Youth

Juvenile concussions in mice linked to progressive changes in the brain later in life

A groundbreaking new study published in Experimental Neurology found that a single juvenile concussion in male mice led to progressive changes in white matter across their lifespan. This study, led by Andre Obenaus, observed changes in the brain structure of three groups of juvenile mice at 1, 3, 6, 12, and 18 months after experiencing a “mild” concussion, a “severe” concussion, or no concussion (for a control group). The researchers used neuroimaging to track changes in the corpus callosum, the largest white matter structure in the brain. Their results suggest that “long-term monitoring of children with juvenile concussive episodes using dMRI is warranted” to keep an eye on vulnerable tracts of white matter.

The researchers randomly assigned the mice to three groups (sham group, grade 1 concussion group, grade 2 concussion group). Grade 1 concussion group (G1) was put under anesthesia and received an impact to their head at around 2 m/s. To simulate the variation in the nature of concussions humans experience, they also created a grade 2 concussion group. The mice in this group received a slightly faster impact at 3 m/s, creating a more “severe” concussion than grade 1. The sham group was put under anesthesia, like the other groups, but did not receive any impact, as they would use this group to control variables.

Obenaus and his colleagues looked for changes in brain structure at 1, 3, 6, 12, and 18 months post brain injury using diffusion MRI (dMRI) to create detailed images of brain tissue and the effects on white matter tracts in the brain. Mice in group G2, which received a more severe concussion, showed dramatic changes in the corpus callosum structure after just 3 months post-concussion compared to G1 mice, where researchers first saw changes at 12 months. These changes persisted (and, in the case of some measures, worsened) throughout the 18-month study window, indicative of persisting axonal damage. The corpus callosum is the main communication highway for both hemispheres and is critical for motor skills, sensory processing, and cognition.

After 18 months, they used post-mortem immunohistochemistry (IHC), analyzing brain tissue samples taken after death. Scientists use this method to understand and specifically identify the causes of brain damage. Compared to the control group, the mice that experienced a grade 2 concussion showed signs of chronic inflammation and structural alterations in their brain cells. Specifically, the researchers found differences in two types of brain cells: astrocytes and microglia. Astrocytes help maintain stability in the brain by regulating the blood-brain barrier, removing waste and excess ions, regulating cerebral blood flow, and transporting nutrients to neurons. Microglia are part of the immune system and “regulate brain development, maintenance of neuronal networks, and injury repair” through promoting inflammatory responses in the brain after injury. Using IHC, the researchers observed that the astrocytes in the grade 2 concussion group had less complex shapes than those in the control group, while microglia showed hyperactivation (indicating a dysregulated and persisting inflammatory response to injury). These abnormalities offer a potential explanation for the observed progressive white matter damage.

Dr. Andre Obenaus and his team found that childhood concussion does, in fact, create vulnerability later in life in juvenile mice. In an article for University of California, Riverside News by Iqbal Pittalwala, Obenaus draws parallels between the persisting structural injury seen in this mouse study and increasing evidence of persisting changes in the brain following concussions in humans. Dr. Obenaus reinforces these observations in the article, stating, “‘Children who experience a concussion should not be declared ‘fully recovered’ based only on short-term symptoms. Subtle changes may take years to show up and, by then, interventions may be more difficult.’”

You Can Support Concussion Patients

Become a Concussion Ally

Join our community of monthly donors committed to improving how concussions are prevented, managed, and treated, thereby supporting long-term brain health for all. Learn more.

Other Ways to Support

You can also make an impact with a one-time gift or tax-friendly options such as Donor Advised Funds (DAFs), IRA Charitable Rollovers, and Planned Giving: leave a gift in your will. Learn more.