Cannabis and Sleep Research (7/3/19 newsletter)

Jul 7

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

Editor: Galen Moller
Contributors: Eloïse Cowan, Micalie Hunt, Hannah Kennicott, and Julian Szieff.

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Education

Canadian nonprofit Parachute provides “researched, evidence-based and expert-advised resources” to help Canadians avoid serious, yet preventable injuries. Parachute Safe Kids Week, an annual campaign in partnership with Hydro One, raises awareness of child safety issues such as falls, the leading cause of injury to Canadian children. Their website and social media (#FallProofYourHome on Twitter) provide checklists, tip sheets, and videos to help parents fall-proof their homes and keep children safe at play.

A Canadian non-profit concussion resource organization, Concussion Awareness Training Tool (CATT), now has a Return to Work module; some sections are universal, and others are specific to Canadian employers and workers. The course has recognition, response, prevention, and management components. Also available is an excellent Return to Work guideline, which applies to any nationality, and provides detailed step-by-step recommendations for returning to work. A video produced by City News 1130 discusses the hurdles of returning to work after a concussion and the new Return to Work guidelines.

Sports

Associate Professor Michael Buckland, a leading Sydney researcher, has discovered Chronic Traumatic Encephalopathy (CTE) in two former rugby league players after conducting their autopsies. His discovery marks the first time CTE has been identified in rugby league players anywhere in the world. In recent years, the NRL has improved its concussion protocol stating that the welfare of the player is the most important element in the management of concussion. Those players who do suffer a concussion must undergo strict assessment and be cleared by a doctor before being allowed to return to play.

After an incident with Pirates catcher Francisco Cervelli, Major League Baseball may change the rules for player re-entry after concussion testing. The Pittsburgh Associated Press recounts how Cervelli suffered a brain injury after being struck by a broken bat, though field assessment declared him fit to play. Pirates general manager Neal Huntington says, “if a player knows he must leave a game to enter concussion testing, he’s less likely to report symptoms.” Consequently, he hopes to lead change in the concussion assessment system and alleviate the pressure for players to stay in the game rather than undergo medical testing.

A recent editorial in The Sydney Morning Herald says that while helmets do decrease the risk of skull and ear injuries, helmets do not prevent concussions. In fact, brain injuries in the NFL increased in the 1970s after hard helmets were introduced. Dr. Alan Pearce, a leading neuroscientist, explains that helmets do not prevent the brain from moving in the skull during trauma.

The Monthly published an article that is critical of the Australian Football League’s response to the concussion epidemic. In 2017, the AFL reported an annual average of seven concussions per team. But this conflicts with a former club doctor, who claims that the rate is two and a half times higher. Additionally, 80% of the players who sustained a concussion were cleared to play the following week.

Cannabis

Sleep issues such as decreased sleep time and trouble falling asleep are a frequent and debilitating part of many concussion patients’ recoveries. A new survey from Goodhines et al., published in Health Psychology, studied 83 college students over 14 days as they filled out daily diary entries on their use of cannabis to aid sleep. The survey found that using cannabis as a sleep aid predicted longer sleep and decreased time awake at night, but also increased next-day fatigue. This research is in line with several previous studies showing that THC in cannabis reduces the amount of REM sleep, which is important for memory and restfulness. This research should encourage caution in the use of cannabis as a sleep aid. Cannabis may aid sleep if one chooses cannabis strains or tinctures with high CBD and low THC, according to Harvard-trained physician, and cannabis therapeutics specialist, Dr. Jordan Tishler, who recommends a strain with “less than 20 percent THC.” Additionally, more research is needed on the effect of cannabis in patients with insomnia.

Diagnostics

Machines could soon pioneer a new approach to care for sports-related concussions, according to an article in Science Daily. Researchers Michael F. Bergeron et al., from Florida Atlantic University, have begun teaching machines to identify patterns in recovery from sports-related concussions in high school athletes. The machines predict concussion recovery times by pairing datasets of concussive injuries in football and other contact sports with patient symptoms such as headaches, dizziness, and difficulty concentrating. With supervision, the machines could become an effective tool in helping clinicians to provide individualized treatment and determine when an athlete should return to play. The study was published by Medicine & Science in Sports & Exercise.

Therapies

The Journal of Experimental Pharmacology published the work of Yuriy I. Sysoev et al. that looked at a potential therapy for TBI symptoms in rats. The researchers found that a new ethanolamine derivative “FDES” improved the limb functioning of rats that sustained brain injuries without negatively affecting the rats psychologically. Several ethanolamine derivatives have already been used in pharmaceuticals.

Veterans

An article from The News Service of Florida highlighted that Governor Ron DeSantis signed a law to render alternative treatment options available to veterans suffering from traumatic brain injuries (TBIs) and post-traumatic stress disorder (PTSD). A wide array of alternative treatments such as service animal training, accelerated resolution therapy, hyperbaric oxygen therapy, music therapy, and equine therapy could soon be available.

A new long-term study conducted by the VA, Department of Defense, and volunteers would follow thousands of veterans diagnosed with an mTBI while in combat. As reported by the website Military, these veterans would undergo sampling and imaging to identify new biomarkers of brain injury and PTSD. The veterans’ DNA would also be analyzed to determine genetic components of the body’s response to mTBIs.

Mental Health

A newly updated guide for managing mental health symptoms after a concussion is now available from Concussion Awareness Training Tool (CATTonline). The guide goes into depth about the six mental health strategies and recommends using them in combination with “the guidance of licensed health professionals experienced in concussion management.”

Statistics

Elinor E. Fraser et al. have found that younger age, shorter post-traumatic amnesia duration, and higher IQ (pre-TBI) are associated with better cognitive function immediately after a TBI. Younger age and higher IQ were associated with more successful recoveries, while post-traumatic amnesia duration was not. The longitudinal study published in the Journal of Neurotrauma also showed that cognitive function improved between the initial testing and a follow-up appointment two to five years later but still remained well below a control group at the follow-up.

Transportation: Our Opinion

Seattle’s rush to implement electric scooters presents a substantial injury and concussion risk for the city’s residents. John Benson, M.D. in an Op-ed for the Seattle Times details how numerous cities and the CDC found electric scooter use to be incredibly unsafe due to misuse and dangerous riding conditions. Among emergency room admittees for scooter-related injuries, only 5% were wearing helmets, and 40% suffered head injuries. Other disturbing patterns included intoxication while riding the scooter, and high rates of severe injuries--regardless of previous e-scooter experience. We join Dr. Benson in urging Seattle to first fully evaluate the implementation of scooters in other cities before making a decision. Research shows that dockless scooters come with significant risks, and Seattle should take those risks seriously.

Women's Health

The Canadian government is providing one million in funding to a research collaboration that will study traumatic brain injury in women who have experienced intimate partner violence. Supporting Survivors of Abuse and Brain Injury through Research (SOAR) is directed by Paul van Donkelaar, professor at the University of British Columbia Okanagan campus, and Karen Mason, Executive Director of the Kelowna Women’s Shelter. The funding is affiliated with the government’s Strategy to Prevent and Address Gender-Based Violence.

Culture

It may seem as if the action heroes we watch on the big screen are indestructible, but they are just as susceptible to brain injury as the rest of us. According to Vancouver stuntwoman, Lori Stewart, there’s a “sort of ingrained culture in stunt performers to maintain that tough persona, and that you can shake things off.” For stunt performers, a concussion could mean the loss of their livelihoods and setback their career, which means many performers don’t report traumatic brain injuries. Ultimately, Stewart believes that while making movies is important, “it’s not worth anybody’s life.” Hopefully, attitudes in the industry will soon change, as the stunt performer union has teamed up with Concussion Awareness Training Tool to create a concussion protocol tool for stunt performers and employers.