The missing ingredient in concussion education programs (10/31/19 newsletter)

Nov 2

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

Editor: Galen Moller
Contributors: Galen Moller, Julian Szieff, Warren Situ, and Katie Taylor.

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Education

Revised concussion training for education professionals

Professionals in the education system now have access to an updated Concussion Awareness Training Tool (CATT) written specifically for school professionals. The CATT resources are provided by the Canadian BC Injury Research and Prevention unit but are also applicable to school settings in the United States and other countries. This online resource helps educators recognize and manage concussions in students, allowing for a more safe and healthful return to school and an efficient recovery process.

The updated CATT is based on recommendations from several different sources, including the 2017 Consensus Statement on Concussion in Sport. In addition to providing a six-step program for returning to full activity, the CATT recommends that students return to very light, restricted activity 48 hours after the concussion impact, even if their symptoms are not fully resolved. There is a CATT online course available, as well as a PDF for professionals to use and reference.

Sports

“The missing ingredient in concussion education” is now available as a blog post

Cannabis

Federal health agencies voice support for better cannabis research

Marijuana Moment shared a letter from the Director of the National Institutes of Health (NIH), Francis Collins, and the Commissioner of the Food and Drug Administration (FDA), Norman Sharpless, regarding their stance on cannabis research. Both officials explain that while their agencies support more rigorous research into cannabis and cannabinoids, there are “a variety of barriers,” including lack of resources and restrictions from current policies.

First, they write, all of the marijuana used for research in the U.S. comes from one facility in Mississippi. The supply is insufficient and it limits the diversity of products available to researchers. Furthermore, the marijuana produced at this facility resembles hemp more than commercially-sold marijuana (cannabis) products. Industrial hemp, as defined by federal law, has no more than 0.3 percent THC, whereas most marijuana products sold in dispensaries have a much higher percentage of THC. Additionally, under federal law, researchers are not allowed to purchase marijuana from state-legal shops, which exacerbates the gap in our understanding of how these products affect people’s health. Despite applications for additional cannabis manufacturers, there have been slow responses from the Drug Enforcement Agency.

Diagnostics

Alzheimer’s and TBI’s overlapping symptoms may lead to misdiagnosis, but MRI imaging may help diagnostics

A new study from Meysami et al., published in the Journal of Alzheimer's Disease, confirms that MRI can be used to differentiate between memory loss caused by TBI and memory loss caused by Alzheimer’s Disease. The researchers looked for patterns of atrophy in the brains of 40 patients who’d experienced memory problems after a TBI. They analyzed the patients’ MRI scans with a software program to identify which regions of their brains showed the most volume loss when compared to a database of brains without a history of TBI.

In patients with a history of TBI, the most atrophy occurred in a region of the brain associated with learning and emotions called the “ventral diencephalon.” The area that showed the least atrophy was the hippocampus, which is associated with memory and emotions. According to a news release from UCLA, this is significant because, in Alzheimer’s patients, the hippocampus is where much deterioration occurs. The difference between a patient with TBI and a patient with Alzheimer’s Disease can easily be visualized on MRIs using the software from this study. By diagnosing correctly, targeted treatments can be given to address the differing disease paths.

Therapies

How vision and neck symptoms help and hinder each other

In a Healio blog post for the Neuro-Optometric Rehabilitation Association, June Chiang, OD, explains why optometrists should care about the neck—especially when their patients have a history of brain injury. Untreated visual dysfunction can lead to compensatory posturing and cause imbalances in neck muscles, along with chronic neck pain and cervical tissue damage. Addressing visual problems can help patients return to a better posture, since they don’t need to compensate, and this can improve their proprioception and diminish their pain. Chiang says that this works in the opposite way as well. Just as treating vision can improve cervical mechanics, treating head and neck control can make it easier for the visual system to integrate and process stimuli.

Chiang advises her colleagues to be aware of brain injury patients’ needs and risks. She says what has helped her the most in her practice is taking a step back to get “the big picture, the whole picture of the patient,” by considering what other body systems and social systems might be at play in their visual dysfunction.

Veterans

South Dakota ranch works to end veteran suicide by offering free equine therapy

An article published in U.S. News by the Associated Press tells the story of a therapy horse named Max and his work at the DTOM 22/0 Ranch in South Dakota. Chris Reder, Max’s current owner and the founder of the DTOM 22/0, brought Max to the ranch because he wanted to provide more holistic therapies to veterans with PTSD, TBI, chemical dependencies, and other neurological issues. Max is trained for use in the Draper Sensory Method, which involves a series of horseback drills designed to lower stress levels and reset chemical imbalances in the brain by creating “core muscle and rhythmic movement simultaneously within three body planes.” Max is one of only a small number of horses who can consistently perform this therapy, and DTOM 22/0 is one of only 4 U.S. ranches currently offering it.

The name DTOM 22/0 comes from the old military phrase, “Don’t Tread On Me,” combined with the current average number of veterans who die from suicide each day (twenty-two), and what the number should be (zero). In an interview with Aberdeen American News, Reder explained, “We worked very hard to raise the money for the schooling to purchase Max and (to) build the arena and lean-to shelter to house him because we need a real sense of urgency. Veteran suicide is not going away, so we need to do more immediately.” Eventually, Reder wants the ranch to become a retreat for veterans, where they will be given lodging, support, and volunteer opportunities in addition to equine therapy, all at no cost to them, because they have “sacrificed and carried that burden already.”

Mental Health

Upcoming lecture series on mental health

The Northwest Brain Injury Symposium (NBIS) is opening its 2019-2020 lecture series next Saturday, November 5th, with the lecture, “Finding Your Path: Brain Injury and Mental Health,” hosted at the Spokane Public Library. This free event is an opportunity to connect with local concussion resources and community members while learning more about the complex interactions between brain injuries and mental health.

The lecture will feature a speakers’ panel of experts to discuss topics including, but not limited to, community re-integration, risks of suicidal ideation, and the impacts of depression and anxiety on cognitive functioning. The event will begin at 5:00 PM with a resource fair, and the panel lecture will start at 6:00 PM. For more information or to RSVP, go to the invitation on Eventbrite. NBIS also makes all of their lecture series available on their youtube channel.

Statistics

“TReNDs” in the brain after TBI; 9.7 million dollar grant to analyze neuro-degeneration

Several forms of neurodegeneration have been observed after TBI, including (but not limited to) CTE. Little is known about any of these neurodegenerative conditions, which is why researchers are currently describing them with the umbrella term “TBI-Related Neuro-Degeneration,” or “TReND.” According to an article in The Philadelphia Inquirer, The National Institute of Neurological Disorders and Stroke has given The University of Pennsylvania a $9.7 million grant to study these different degenerative disorders and gain a better understanding of the implications of TBI on an individual’s brain for the long term.

With the University of Pennsylvania’s Perelman School of Medicine as the hub for 12 institutions, they will form “CONNECT-TBI:” a network of brain banks linked to comprehensive datasets of TBI and Alzheimers and Dementia cases. The size of the system will allow the researchers to compare a large number of preserved brains, and analyze degeneration on a scale large enough to see the effect of TBI across time and population.

Women's Health

“Need for TBI testing in standard forensic nursing exams” is a now available as a blog post

Culture

Stanley Cup champion Daniel Carcillo and UFC champion Cris Cyborg talk about concussions, life, and finding purpose in sports

“We are sitting here talking for a reason. And maybe that reason is so that more people can understand signs and symptoms.” This was one of the points which Daniel Carcillo brought up during his visit to Cris Cyborg's home, in a video filmed for The Players’ Tribune. He stopped by to check on how she’s doing after losing her match and getting a brain injury. Cyborg says that winning is not her concern.

Whether it is a victory or a loss, injuries are sustained in MMA, and that is the most frightening part of her job. Despite coming from different sports, both Cyborg and Carcillo know what it’s like to live with the possibility that they might lose their memories or not be able to care for their families. But even so, Cyborg feels that her life’s purpose is intertwined with MMA. She and Carcillo also talk about functional neurology and the feeling of optimism that comes from finding treatments that work.