Helping youth recover (12/19/19 newsletter)

Dec 23

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

Editor: Galen Moller
Contributors: Olivia Collis, Conor Gormally Kenta Hikino, Hannah Kennicott, Evie Kortanek, Ben Preiss, and Trinh Tieu

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Education

SCHOOLFirst tool provides information for assisting youth with concussions after returning to school

The Holland Bloorview Kids Rehabilitation Hospital in Toronto, Ontario created a tool called SCHOOLFirst for adults to support youth with their return to school after a concussion. The tool is a 36-page free interactive PDF file produced by researchers, healthcare professionals, translators, writers, school administrators, family members, and youth. It provides summaries, simple diagrams, and a planning tool with current research on pediatric concussion care with links to various articles, websites, and videos. It contains basic information on what a concussion is and when a student should go back to school, as well as more specific advice for educators, coaches, parents, and adults looking to assist youth and develop new concussion policies in schools.

Teachaids and USA Football partnership utilizes CrashCourse curriculum to improve youth football safety

In a blogpost, the Stanford-affiliated nonprofit Teachaids announced its collaboration with USA Football to advance “smarter play across America’s favorite sport through TeachAids’ CrashCourse curriculum.” This free curriculum teaches viewers to empathize with individuals who have experienced concussion and to recognize concussion signs and symptoms. USA Football will award a certificate of completion to each individual that completes the CrashCourse.

USA Football CEO Scott Hallenbeck notes that education is an indispensable tool in the “reimagining” of youth and high school football. Stanford University football coach and CrashCourse advisor David Shaw echoes this sentiment, asserting that “providing compelling and accurate education to our young players, their parents, and coaches” is the key to making football “as safe as possible for all who play it.”

Concussion Alliance partners with Teachaids to present their CrashCourse Concussion Education. The Teachaids CrashCourse video can be viewed on our website here.

Sports

England’s Premier League, globally famous pro soccer league, contemplating reformed concussion measures during games

An article from the soccer website This is Anfield reports that England’s Premier League is weighing options to introduce concussion substitutions in its games for next season. Convening in February, the International Football Association Board (IFAB) is appointing a group of medical experts to help introduce concussion substitute protocols. There are two suggested methods for conducting the substitution: the first proposes that players with a possible concussion could be substituted without it counting towards professional soccer’s three substitutions per match rule; the second option would allow the potentially-concussed player a temporary substitution for a 10-15 minute evaluation that will either clear them for return to play or make the substitution permanent.

At the moment, IFAB is not considering using neutral doctors to assess concussions as advocated by the international professional players’ union. The Premier League is planning on reviewing the IFAB’s recommendations and holding a vote among its 20 clubs after further discussion. Such rule changes are bound to start a debate concerning teams manipulating these substitutions to gain a tactical advantage, but players’ health and safety should be the priority.

Cannabis

CBD holds promise to improve the functional recovery of complex learned behaviors following brain injury

A recent dissertation published in Neuropharmacology found that cannabidiol use helped vocal learning-dependent recovery from damage to a cortical-like brain region in songbirds. The researchers, Ali Alalawi et al., administered daily 10 mg/kg and 100 mg/kg doses of CBD to songbirds who had had their learned vocalizations disrupted by microlesions on the brain region that drives song.

These microlesions destroy about 10% of the brain region and temporarily impair song production, syntax, and phonology for about seven days. Recovery requires sensorimotor learning as it depends upon auditory feedback. Results indicated 10 mg/kg and 100 mg/kg CBD effectively reduced the time necessary to recover vocal phonology and syntax. In the case of phonology, the magnitude of microlesion-related disruptions was also reduced. The researchers conclude that “CBD holds promise to improve functional recovery of complex learned behaviors following brain injury, and represent establishment of an important new animal model to screen drugs for efficacy to improve vocal recovery.”

Diagnostics

The complications of children's concussion recovery

While most children fully recover from concussions, one in ten will continue to suffer from lingering symptoms. A news release from the University of Queensland (UQ) reported how its researchers are delving into the relationship between improper concussion recovery and lingering symptoms in children. The researchers’ study could clarify the long-term risks of concussion-related disability for parents and doctors alike. Dr. Kartik Iyer, a research fellow at the UQ Child Health Research Center, explains, “It is critical that children who receive a head injury see a doctor...soon after their injury has occurred.”

According to Dr. Iyer, results of MRI scans of kids with lingering concussion symptoms showed poor sleep “was linked to decreases in grey matter” and reduced brain function. Children often continue to struggle with school work, memory retention, sleep, and mood swings if they have lingering symptoms. UQ’s KidStim laboratory is trialing a “non-invasive brain stimulation therapy” for kids with lingering symptoms, including several forms of Transcranial Magnetic Stimulation. Dr. Iyer also highlights that the study’s results “can help clinicians ensure a child receives targeted rehabilitation such as cognitive behavior therapy, medication to improve sleep...to potentially reduce symptoms.” Families who want to register their interest in this study can contact the Acquired Brain Injury team.

Therapies

An antibody that treats TBI and prevents progressive neurodegeneration in mice as a promising treatment for human brain injury

A recent article published in Men’s Health discusses how the work of Harvard Medical School researchers Kun Ping Lu and Xiao Zhen Zhou has advanced since 2015, when they discovered an antibody that blocks the post-trauma induction of neurotoxins in mice brains. At the time, they were investigating the process by which tau—a protein essential to building and supporting axons—deforms into the neurotoxic “cis tau,” which, in high concentrations, can lead to axonal degeneration. They detected a progressive increase of cis tau in human and mouse axons following head trauma. This deformation of tau following brain injury, dubbed “cistauosis,” is considered a “major early driver of disease after TBI,” with links to chronic traumatic encephalopathy (CTE) and Alzheimer’s disease.

As joint supervisors of a study published in Nature by Asami Kondo et al., Doctors Lu and Zhou discovered that the cis tau antibody blocked cistauosis following head trauma in mice and prevented the development of neuropathologies involved in CTE and Alzheimer's. They were able to treat the rodent equivalent of TBI before it could lead to progressive neurodegeneration. Now, four years later, researchers at Pinteon Therapeutics have developed a variant of the antibody for human trials, which started recruiting this past October. Bill Meehan, M.D., Director of the Micheli Center for Sports Injury Prevention at Boston Children’s Hospital, thinks that the cis tau antibody is “one of the most promising therapies out there” with potential applications in detecting and treating TBI as well as preventing neurodegenerative diseases after brain injury.

Veterans

Preliminary research in mobile neurofeedback for pain management in veterans with TBI and PTSD

A preliminary study published in Pain Magazine found promising early results regarding the use of a portable EEG neurofeedback unit in treating chronic pain for veterans with TBI and PTSD. The portable neurofeedback unit was connected to a mobile application that allowed the 41 veterans who participated in the study to self-administer neurofeedback sessions from their home. The veterans, who averaged 33.09 ten-minute sessions over three months, “reported lower pain intensity, pain interference, depression, PTSD symptoms, anger, sleep disturbance, and suicidal ideation… compared with baseline.”

While Eric B. Elbogen et al. acknowledge the need for a double-blind trial with a randomized subject group to confirm the effectiveness of the treatment, they accomplished their objective of determining the feasibility of the treatment method and had positive results: “veterans reported reduced pain intensity 67% of the time immediately following mobile neurofeedback.” Neurofeedback has been used as a pain-management tool before, but previously required patients to be in-clinic. The development of an effective mobile neurofeedback tool could make it a more accessible pain management tool for patients with TBI.

Mental Health

Boys showing inattention, hyperactivity, and externalizing problems have an increased risk for TBI

A study by Guberman et al. published in The Canadian Journal of Psychiatry found that treatments to reduce inattention, hyperactivity, and externalizing problems (acting towards others) could reduce the risk of TBI in males up to age 34. Healio reports that the study analyzed data from 727 Canadian males, ages 6 to 34 years old, to determine if inattention, hyperactivity, and/or externalizing problems at age ten were associated with subsequent TBIs up until age 34.

The study concluded that inattention, hyperactivity, and previous history of TBIs could predict a male’s chance of sustaining a TBI during ages 11 to 17. Externalizing problems by age ten could predict male’s likelihood of sustaining a TBI during ages 18 to 34. Therefore, they suggest that treatments to reduce inattention, hyperactivity, and externalizing problems for boys would be beneficial to decrease their risk of TBIs until age 34.

Statistics

Concussions in youth

Jennifer Clopton recently published an article on WebMD detailing the high prevalence and dangers of concussions among kids. As initially reported by the CDC in March, children sustain around 1.1-1.9 million sports and recreation-related TBIs every year, but only 283,000 of those children end up in emergency rooms. The article highlights disparities in concussion rates, diagnoses, and recoveries between different races and genders. It concludes with a call to action to better prevent and manage concussions in young people, specifically by increasing the awareness of warning signs and accessibility to athletic trainers.

Women's Health

New educational resource outlines current evidence of sex-differences in concussion

The Neuro-Optometric Rehabilitation Association has released a new educational resource, “Women & Concussions,” that provides information on observed sex differences in concussion. It highlights that “There is little known about the specific effects of TBIs on women, mainly because the majority of studies on the subject have focused more on men.” Despite this gap in concussion research, there is a growing body of evidence that suggests that women are at higher risk for sports-related concussions than men and experience a greater number and longer duration of concussion symptoms.

The resource cites sex-differences in brain axon structure, neck strength, and hormones as possible explanations for the observed sex-differences in concussion vulnerability. It also notes recent findings that female athletes seek and receive specialty care for concussion later than male athletes, potentially because the sports girls tend to participate in—such as cheerleading—do not receive as much attention as male-dominated sports such as football.

Culture

Study indicates that TBI may be a consequence or cause of homelessness

A research study published in The Lancet Public Health indicated that half of all homeless and marginally housed individuals may have had a traumatic brain injury (TBI). Using data from six countries (Australia, Canada, Japan, South Korea, the UK, and the US), the researchers, Jacob L. Stubbs et al., determined that 53% of people experiencing homelessness have had a TBI in their lifetime. This figure is approximately 2.3 to 4 times the rate for the general populace. Additionally, a quarter of the homeless population studied had a brain injury that was moderate to severe, which is nearly ten times more common than in the housed population.

In their editorial about this research for The Lancet Public Health, Jesse T. Young and Nathan Hughes commented: “It is becoming clear that TBI can be both a cause and a consequence of homelessness. The functional and socioeconomic consequences associated with TBI can present challenges to finding and retaining housing.” They then call for a trial to investigate whether providing housing for people experiencing homelessness is effective in reducing their rate of traumatic brain injury.