How to make soccer safer (11/7/19 newsletter)

Nov 11

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

Editor: Galen Moller
Contributors: Galen Moller, Katie Taylor, and Warren Situ

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Education

Why Washington needs to catch up on return-to-learn protocols

While other states have return-to-learn laws that define how to support students in their return to academics after a TBI, Washington State has none. To understand why this is the case, KIRO 7 turned to Dr. Monica Vavilala, the director of Harborview Medical Center’s Injury Prevention and Research Center. Part of the problem, she said, is that the state lacks a central database for tracking concussions in schools, which is necessary for developing a comprehensive Return-to-Learn plan. Thus, concussion accommodations vary greatly between schools and across school districts. Some schools do not have any support programs in place, which forces students to fight for accommodations while still trying to keep up with schoolwork and recover from their injury. But Dr. Vavilala is trying to change this.

She and her team at Return to Learn Washington have already studied 118 students across five different high schools and created a pilot Return-to-Learn program. With a $570,000 grant from the CDC, they will be able to expand this program to 24 public high schools across the state. Vavilala says, “anybody who's a TBI champion can go through the checklist we've developed, identify the symptoms, and map those symptoms to accommodations and make those recommendations to the teacher.” The program is currently recruiting public high schools in Washington with more than 50 students to take place in this study.

Sports

American Academy of Pediatrics on the risks of youth injury in soccer

A clinical report in Pediatrics by Andrew Watson et al., generated by the American Academy of Pediatrics (AAP) Council on Sports Medicine and Fitness, discusses risk factors and prevention tactics for youth injuries in soccer. While the AAP maintains that soccer is a beneficial component in the lives of most athletes, it also warns readers that the risk of injury in the sport is increasing. The authors refer to a recent retrospective study on children aged 7–17 years old who visited the emergency department for soccer-related injuries between 1990 and 2014. Researchers Smith et al. found that in this time frame, the annual number of soccer-related injuries increased 111%, and the rate of concussions relative to playing time increased by almost 1600%. There is insufficient data to determine whether this trend is indicative of higher rates of head injuries or better concussion reporting practices.

Nonetheless, the AAP offers several concrete steps to decrease head injuries. Although heading the ball is the activity most associated with concussion, the mechanism of most soccer injuries is contact with other players, instead of head contact with the ball. Emphasizing fair-play rules, enforcing regulations, using age-appropriate balls, and teaching proper heading techniques, could help decrease concussion and injury risks. The clinical report also discusses orthopedic injuries, especially ACL tears and specific steps that coaches can take to prevent these.

Cannabis

Treating different kinds of pain with cannabis and cannabinoids

Researchers Karma Rabgay et al. published a literature review in the Journal of the American Pharmacists Association to summarize what we currently know about the best ways to administer cannabis and cannabinoids for different kinds of pain. They searched databases for research published through June 2017 and used data on 2270 patients from 25 studies.

The studies found that products that deliver THC, with or without CBD, via the oromucosal route (e.g., mouth sprays), could help decrease neuropathic pain, which develops when the nervous system is damaged or not functioning properly. Inhaling the smoke of standardized dry cannabis that contains THC also reduced neuropathic pain scores. Other studies showed that oral delivery of standardized cannabis extract with THC could help reduce nociceptive pain, which occurs as a warning signal from an injured area of the body. The researchers encourage product developers to take these findings into account so they can use the most effective methods for different kinds of pain control.

Diagnostics

Neck pain in concurrence with concussions

A study published in Physical Medicine and Rehabilitation aims to determine the frequency and severity of neck pain after concussions. Researchers Jeffrey A. King et al. used the Sport Concussion Assessment Tool 3 to measure the frequency of neck pain in patients admitted to the emergency department for mTBI. Three days post-injury, 68.4% of patients had neck pain, and 35.8% of patients had neck pain that was similar to or worse than all other concussion-related symptoms. These percentages increased significantly among patients involved in motor-vehicle crashes. This study indicates that a cervical injury should be considered as “an important potential concurrent diagnosis in patients with mTBI.”

Therapies

“Doctors address concussion recovery in pediatric treatment” is now available as a blog post

Veterans

Navy scientists developed blast sensors to improve brain injury detection

Normally, the Department of Defence requires that everyone within a 165 feet radius of an explosion “stand down” for 24 hours and complete a medical checkup. In an interview with Techlink, Dr. Timothy Bentley, an expert in traumatic brain injuries at the Office of Naval Research, explained that this can be impractical. Some forward-operating bases are only 300 feet across, so more than half of the staff must stand down every time there is a blast event. More importantly, 24 hours is not enough time for a regular medical exam to detect an mTBI.

To improve the diagnosis of brain injuries in the field, Dr. Bentley, along with Drs. Peter Finkel and Margo Staruch of the Naval Research Laboratory’s Materials Science & Technology Division, invented a highly-sensitive blast-proof sensor, which can “predict and analyze traumatic forces more accurately than current tools.” The sensors are small—about the size of a coin—and can attach to headgear and body armor. Doctors can quickly convert data from these sensors into a “‘go or no-go’ injury threshold,” to determine if military personnel involved in a blast need to be examined or can continue fighting. In April, the Navy filed to patent the technology, and the device could eventually be licensed to private companies for manufacturing and sales in partnership with the Navy.

Mental Health

Cognitive Behavioral Therapy for PTSD is appropriate in patients who have an mTBI

A review of research studies concerning treatments for post-traumatic stress disorder in patients with a history of TBI found that studies using forms of cognitive-behavioral therapy (CBT), often in combination with other treatments, had positive results. A smaller number of studies found positive results with “complementary and novel” therapies, such as hyperbaric oxygen therapy and brain and vestibular rehabilitation, but the quality of these studies was considered low.

The authors, Ana Mikolíc et al., conclude that CBT “seems appropriate” for patients with a history of TBI. They note that their information is limited by the fact that most of the studies they reviewed focused on “male service members and veterans with a history of mild TBI in the United States.” The review was published in Clinical Psychology Review.

Statistics

If you've had a TBI, you may be at risk for seizures

The Daily Mail recently highlighted a manuscript from the Archives of Physical Medicine and Rehabilitation about the connection between traumatic brain injuries and seizures. According to authors Jeffrey Englander et al., most TBI cases do not result in seizures. But if they do, it indicates the potential for more seizures in the future. About 25% of people who have a seizure in the first week after a brain injury will have another seizure months or years later. About 80% of people who have a seizure more than one week after their brain injury will have another seizure.

The good news is about 70–80% of people who have seizures respond to medications and can return to normal activities. If medications don’t work, your doctor may refer you to a Comprehensive Epilepsy Center to find the most appropriate treatment. It’s important to remember that if you have a seizure after a TBI, there’s a chance it could happen again, so friends and family should be informed about how to keep you safe during an epileptic episode.

Women's Health

Boston University recruits for first-ever all-female CTE study

The Boston University CTE Center is currently recruiting professional female soccer players over the age of 40 for its “Soccer, Head Impacts and Neurological Effects (SHINE)” Study. SHINE will be the first all-female study dedicated to understanding chronic traumatic encephalopathy (CTE). Dr. Robert Stern, the lead investigator of SHINE, told NBC News that when it comes to sports-related brain problems, women have been especially understudied.

According to The Brink, Boston University’s scientific news site, there are only two recorded cases where a woman was diagnosed with CTE. Meanwhile, Boston University researchers have diagnosed CTE the brains of “hundreds of deceased men—most former pro-football players and some military veterans.” Some studies found that soccer players may have an increased risk for CTE, but these studies only used male subjects. In his interview with The Brink, Dr. Stern indicates that SHINE could give us insights into sex-based differences in CTE.

Former US soccer stars Brandi Chastain and Michelle Akers have already announced that they will take part in the study and donate their brains to the CTE Center’s brain bank after they die. For further discussion of their announcement and what it means for soccer and future CTE research, check out our blog post.

Culture

Zipline crashes raise safety concerns in Colorado

Ziplines have become a growing source of lawsuits in Colorado. The Denver Post reported on a recent lawsuit by Lisa Cowles, who suffered a TBI and fractured knees after a zipline sent her careening into a tower—hard enough that her husband could hear the impact from a half-mile above. Cowles is seeking reparations from the company that built the zipline and the resort where her injuries occurred. Her lawsuit argues, “The explosive growth of the commercial zip-line industry has occurred in the absence of consistent or coordinated regulatory oversight.”

The Colorado Division of Oil & Public Safety’s office of Amusement Device Safety Programs has regulated ziplines since 2013. Program manager Scott Narreau says that in the past seven years, the agency received 13 reports of injuries on ziplines. The most common causes are brake malfunctions and patrons who do not engage the brake system properly. There are some cases where private groups were operating ziplines without a state permit because they believed they were exempt from state requirements for professionally-designed zip lines. For the most part, he says, Colorado’s “more than 250 legal ziplines are safe and do not have any reported injuries.” But Cowles’ lawsuit demonstrates that the injuries that result from ziplining accidents can be severe, and the risk for such accidents is growing. In 2015, the American Journal of Emergency Medicine reported that the number of ER visits for zipline-related injuries increased from a few hundred in 1997 to more than 3,600 in 2012. A total of 16,850 people were injured in that period.