1 in 6 concussed youth get a second concussion within 2 years (5/23/19 Newsletter)

May 23

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Education

Concussion Alliance is proud to announce that one of our research analysts, Rebekah Kissel, will be interviewed about concussions and CBD on a regional Canadian radio station. Kootenay Co-Op Radio’s Kootenay Morning with Neil Sorochan will air the 20-minute segment on Wednesday, May 29th during the 8 am PST/10 am CST show. The program will repeat on the same day at 5 pm PST / 7 pm CST.

The National Federation of State High School Associations has partnered with the Arizona Barrow Neurological Institute to create “Concussion for Students.” The program is a free online course formatted as a social media conversation showing how students learn about concussions in different ways.

Sports

A study conducted by Daniel Charek et al. has shown preliminary data indicating that the longer athletes are left in a game after receiving a concussion, the longer it takes for them to recover. This study, featuring 130 athletes aged 11-19, showed those who stayed in a game for more than 15 minutes after concussion as taking the longest to recover and those immediately pulled recovering quickest on average. Those who were immediately removed showed fewer symptoms throughout their recovery compared to those who played more than 15 minutes. This study, published in The Journal of Head Trauma Rehabilitation, shows the importance of removing athletes promptly after a potential head injury.

A 2018 study explored the perceptions of concussions among Canadian surfers. For surfers, head injuries are often brushed off as a result of the cultural and social environment, despite the fact that they are the second most common surfing injury. There is also a common misunderstanding that surfing is low-risk because it's a non-contact sport-- after all, "you're only hitting the water.” These beliefs, coupled with the lack of proper concussion awareness and training, put surfers at risk for head injuries. The study, by Nikolaus A. Dean, is a thesis published in the Open Collections of the University of British Columbia.

The United Soccer League (which encompasses the 2nd-4th tiers of American and Canadian soccer) has proposed a rule change to the International Football Association Board (IFAB) that would allow for a head injury substitution. This proposed substitution is a temporary one that would allow another player onto the field while their teammate is assessed, according to ESPN. USL’s announcement signals an increased willingness to address concussions in sport. However, there are two troubling aspects of this proposal; the decision cut-off time is too short to allow for a proper diagnosis, and the head injury substitute player counts as one of the three substitutes the team is allowed. Read Conor Gormally's in-depth blog post.

This month is the 10th anniversary of the Zachary Lystedt Law, which prohibits youth athletes “from returning to play without the approval of a licensed healthcare provider.” The Washington State law inspired the passage of similar laws in all fifty states. In 2006, 13-year-old Zackery Lystedt was playing football for his school team when he suffered a concussion, was only taken out of the game momentarily, and then returned to play; he suffered second-impact syndrome and catastrophic brain injury after the game.

A study by Timothy McGuine et al. used a cluster randomized trial of over 2,700 participants to determine the effect of soccer headgear on sport-related concussions (SRC). The study, published May 14 in the British Journal of Sports Medicine, found that “soccer headgear did not reduce the incidence or severity of SRC [sport-related concussion] in high school soccer players.”

Diagnostics

A new study has found a novel way to tell the difference between concussion patients with persistent symptoms and those who have recovered quickly by looking at their brains' response time. Using transcranial magnetic stimulation paired with an electromyography sensor on the patient's dominant hand allowed researchers to see delays in muscle reaction to stimulus which were present in PCS but not in recovered concussion cases. This study, by Alan J. Pearce et al. published in Neuroscience has great potential to allow for clinical diagnosis and suggests new avenues for research and treatment. Read Julian Szieff's in-depth blog post.

A Baltimore TV station aired a useful demonstration of the EyeBOX, a groundbreaking device for diagnosing concussions recently approved by the FDA. The EyeBOX is the “first non-invasive, baseline-free tool to aid in the diagnosis of concussion,” approved for 5 to 67 years of age. Oculogica, Inc is starting with a pilot launch with a limited number of qualified sites. The EyeBOX test takes 4 minutes, and patients watch a movie while cameras track their eye movements. In a TEDMED talk, Oculogica co-founder Neurosurgeon and researcher Uzma Samadani, M.D., Ph.D., describes how they discovered that eye movements can indicate concussions, and may someday reveal the severity and location of the injury in the brain.

Mental Health

The National Institutes of Health have given Cole Vonder Haar, assistant professor of behavioral neuroscience at West Virginia University, a five-year, $989,210 award to research potential treatments for the psychiatric symptoms that occur with chronic TBI. According to an article in Newswise, Vonder Haar and his team aim to help people who experience long-term behavioral changes, such as risky decision-making, impulsivity, or shortened attention span. They will examine three different approaches to treatment: the first considers sensitivity to environment and using environmental factors in rehabilitative treatment, the second will test with effects of therapeutic drugs, and the third involves neuromodulation, or indirect stimulation of the brain through the scalp. The study will begin this June.

Veterans

The SHARE Military Initiative at Shepherd Center in Atlanta, GA will provide up to 12 weeks of free intensive rehabilitation to treat mild to moderate brain injury and psychological concerns of anyone who served in the U.S. military since September 11, 2001--including veterans with other than honorable discharges.

Over 400,000 service members have been diagnosed with a TBI since 2000. Of these, 82% are mild TBI (mTBI), which result from a concussion or blast exposure; some service members do not make a full recovery and have persistent cognitive deficits, according to Globalnewswire. At the Walter Reed National Military Center, Dr. Louis French is heading a study using a computer program, BrainHQ, in an attempt to rehabilitate current and former service members. This trial, which included eighty-three participants with TBI, has had promising results, with BrainHQ users outperforming those playing computer games in tests of cognitive function. Unfortunately, certain tasks related to ease of day-to-day life have not shown significant improvement. However, these results and the program itself are still in the early days of testing. The study was presented at the 9th Annual Traumatic Brain Injury Conference in Washington, DC on May 16, 2019.

Statistics

A retrospective cohort study found that “1 in 6 youth diagnosed with a concussion are diagnosed with a subsequent concussion within 2 years,” with the risk of repeat concussion being lowest for ages 5-8 years (9.5%) and highest for the oldest group studied, youth ages 12-15 years (19.8%). The authors Allison E. Curry, Ph.D., MPH, et al. found that two factors significantly further increased the risk of repeat concussions. If the patient took over 30 days to recover, the risk of a second concussion further increased. For example, youth ages 12-15 who took over 30 days to recover had a 32.7% risk of a repeat concussion within 2 years. Having a large number of concussion symptoms also increased the risk of a repeat concussion. The study found that youth ages 12-15 who had over 11 concussion symptoms had a 42.2% risk of a second concussion within 2 years. The study was published in The Journal of Pediatrics.

Neurologist Kim Gorgens’ 2018 TEDTalk examines the correlation between head injuries and crime. She found that 50-80% of the people in the US criminal justice system have experienced an mTBI or TBI, compared to 5% in the general population. Those convicted of crimes often also face other challenges that can compound the effects of a TBI, like substance abuse and repeated physical violence. Gorgens’ team in Denver works with probationers individually to decrease their chances of re-arrest.

Transportation

A study by Austin Public Health and the Center for Disease Control, which looked at e-scooter use resulting in an Emergency Room visit in Austin, found that 48% of the injuries resulting from scooter use involved head injuries, including fractures, lacerations, and abrasions. Of the 190 injured riders in the study’s three-month time frame, 15% suffered a traumatic brain injury. The traumatic brain injuries included “concussions and other forms of altered mental status or bleeding such as subarachnoid hemorrhage and subdural hematoma.” Only one of the injured riders was wearing a helmet. The authors of the study note that “this study likely underestimates the prevalence of e-scooter related injuries” as it didn’t include “injured riders seeking medical care at an urgent care center or physician’s office,” which is more likely where a person would go if they received a concussion.

This week saw “the first fatality involving a dockless e-scooter in the City of Atlanta,” according to ThreadATL; the e-scooter rider was involved in a collision with a car.