Performance on mobile games linked to cognitive function (9/26/19 newsletter)

Sep 26

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

Editor: Galen Moller
Contributors: Galen Moller and Julian Szieff.

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Education

New online programs from U Michigan in concussion awareness

To recognize and address the concussion issues we currently face, it is important to educate professionals and all people interested in concussions. In response to this need, the University of Michigan has developed two programs: one, a professional certification program targeted at those who work with high school athletes, and the other, a general awareness program to “provide practical up-to-date concussion knowledge for athletes, parents, coaches, and others involved in youth sports.” The latter is designed to teach people how to recognize and recover from a concussion, and will include lectures from experts in neurology, coaches, and athletes with experience in sports-related concussions. This course is free, takes only 2 hours, and is available on Coursera.org.

Sports

Risks of repetitive hits in youth tackle football

According to Julie Stamm, PhD, clinical assistant professor at UW-Madison’s Department of Kinesiology, the dangers of youth tackle football don’t just come from the potential for head injuries, but also from the effects of “repetitive subconcussive impacts, or hits that don’t cause concussion symptoms,” on young brains. Stamm says it’s important that parents and coaches “understand that you don’t actually have to hit your head to impact the brain. A blow to the body can transmit forces that cause a concussion or subconcussive damage, too.” In her guest column for Madison, Stamm explains that the human brain undergoes massive amounts of development during childhood, and repetitive brain trauma during this time may have more severe effects than it would in later years.

Stamm clarifies that letting a child play tackle football does not necessarily increase their risk of getting CTE. But we do know that repeated brain trauma is associated with the disease, and therefore the repetitive hits that are inherent to tackle football are cause for concern.

Cannabis

Project CBD survey gives insight into CBD use

Project CBD, a nonprofit focusing on medicinal uses of CBD and cannabis, recently published the results of their survey on the use and effects of CBD. With 3,506 respondents and over 200 questions, it is “one of the most comprehensive research surveys to date on the use of CBD”, and its results reveal some interesting patterns. Half of the respondents were new users, starting within the past 6 months, and reported they were using CBD to help relieve headaches, irritability, and agitation. 90% of respondents reported some benefits in pain perception reduction.

Additionally, participants taking CBD reported improvements in their sleep, with decreased waking at night and less fatigue after waking. In terms of mental health, most patients with a mood disorder took CBD either for anxiety or depression and reported an improvement with this use.

It is important to note that this survey was taken online by visitors to Project CBD’s website so there is a potential for selection bias in the respondents. However, this data provides a fascinating look into the use of CBD for medicinal treatment.

Diagnostics

Performance on mobile games linked to cognitive function

A recent study from the University of Kent concluded that popular mobile games could be used as a measure of cognitive performance, and help doctors better detect changes in brain function. Testing comprised two separate sessions, two weeks apart, in which 21 healthy participants took standard paper-based cognitive assessments and then played Tetris, Candy Crush Saga, and Fruit Ninja for 10 minutes. The researchers, Jittrapol Intarasirisawat et al., used the phones’ sensors to collect data on speed, length, and intensity of tap, swipe, and rotational gestures and when compared to performance on the cognitive assessments, these metrics correlated with players’ visual search abilities, mental flexibility, and inhibition of responses.

Since changes in these abilities are commonly seen in patients with Alzheimer’s Disease, stroke, TBI, schizophrenia, and OCD, mobile games could offer a more enjoyable means of testing for cognitive decline. Gameplay could also be used to monitor cognitive function in athletes who are exposed to TBI. It was published in Proceedings of the ACM on Interactive, Mobile, Wearable, and Ubiquitous Technologies.

Therapies

New treatment targets electrical disruptions in the brain following TBI

When the brain experiences a traumatic injury, there is some local inflammation and there are also repeated large spikes of electrical current. A new study from the University of San Antonio published in the Journal of Cerebral Blood Flow and Metabolism examines the possibility of treating TBI by targeting this electrical excitability. Using a drug that targets and opens the potassium ion channel responsible for this excessive electrical current, they were able to reduce inflammation and cell death in mouse models of TBI. Intriguingly this drug was administered 30 minutes after blunt trauma, which suggests that this treatment could be most effective when administered shortly after an injury.

The hope is that this treatment will succeed where others currently fail. Study co-author Jose E. Cavazos says, “Current antiseizure medications don't prevent the development of post-traumatic epilepsy. Our study examined this critically important therapeutic gap, and proposes a novel pharmacological intervention shortly after TBI that might prevent post-traumatic epilepsy."

More research needs to be done in animals before this treatment could be evaluated in humans, but the potential benefits are exciting to think about.

Service Members & Veterans

UCLA donor Steve Tisch helps fund programs for veterans, children, and NFL

Steve Tisch owns the NFL team the New York Giants, and he’s determined to be on the right side of history, according to an article in GiantsWire. Back in 2014, he donated $10 million dollars to UCLA to fund their research and treatment of concussions. Today, the TBI program, called “the UCLA Steve Tisch BrainSPORT Program,” treats children’s TBI and is one of six NFL TBI treatment centers. They also run Operation Mend, a free intensive TBI treatment program for service members and veterans.

Check out the Concussion Alliance article on seeing a neurologist for TBI, written by Julian Szieff based his interview with Josh Kamins of BrainSPORT, and our page on Veterans and Service Members for more information on Operation Mend.

Mental Health

Children with ADHD show more symptoms in pediatric concussion test

According to a new report published in the Journal of Pediatrics, children with ADHD may perform differently on concussion tests than children without ADHD. Cook et al. administered the Child SCAT5 (Child Sport Concussion Assessment Tool 5th Edition) to 27 uninjured middle school athletes with ADHD, and 27 without ADHD. Subjects were matched based on age, sex, language, number of prior concussions, sport, and school they attended. On average, the children with ADHD reported more symptoms and greater symptom severity, and made three times as many balance errors. They did not perform differently on cognitive tests.

The researchers conclude that their findings demonstrate the challenges of testing for concussions in children with ADHD, and indicate the importance of administering the test to children before they begin athletics, to monitor their progress.

Statistics

A statistic rebuttal for people who criticize girls’ soccer to distract from the risks of full-contact football

Zachary Binney, PhD, an epidemiologist and consultant specializing in sports injuries, wrote an NFL Injury Analytics blog post addressing the defense that tackling in children’s football should be allowed because we haven’t banned girls’ soccer, which causes more concussions than football. He first points out that this is a common deflection tactic, “deployed strategically, often by powerful people, with the goal of stopping you from doing anything if you can’t fix everything.” He then uses data from the High School Reporting Information Online and the NCAA’s Injury Surveillance System to show that even if the logic of this argument were sound, its statistical basis is not. Contrary to popular belief, girls’ soccer is not responsible for more concussions than football.

It is true that concussions account for a larger percentage of injuries in girls’ soccer than in football, but this does not mean that there are more concussions in girls’ soccer. It is also true that the reported concussion rates for girls playing a particular sport are generally higher than for boys playing the same sport, but this does not mean that any girls’ sport, such as soccer, will have a higher concussion rate than a different boys’ sport, such as football. In high school, men’s football not only has a higher concussion rate than women’s soccer, it has the highest concussion rate out of all high school sports.

Furthermore, because football is such a popular sport to play, it is also responsible for more concussions than any other high school or college sport. According to data from the 2017-18 period, there were 103,830 concussions from high school football—nearly twice the number of high school women’s soccer, which reported 59,447 concussions. In college, men’s football caused more than three times as many concussions as women’s soccer. With this information in mind, Binney tells football’s defenders to “stop using bad stats about girls’ soccer to distract from the concussion problem in football.”

Culture

Diplomats in Cuba: Pesticide fumigation likely responsible for mysterious brain injuries

Concussion Alliance has reported previously on possible brain injuries of American diplomats Cuba, in our August 8 and September 5 newsletters. Previously, some experts suspected the injuries resulted from a sonic weapon and other suspected mass hysteria. Global Affairs Canada commissioned a study of these injuries, which was led by Alon Friedman, MD, PhD et al. The research report was then uploaded to SCRIBD by a Radio-Canada investigative TV program.

According to the study, brain injuries suffered by Canadian diplomats while in Cuba were likely caused by regular fumigation (up to 20 times a year) to prevent the spread of the Zeka virus. The fumigation was done both inside and outside the embassy offices and the diplomat's private residences, using a low dose of commercial-grade pesticide. Exposure to the pesticide can inhibit cholinesterase (ChE), an enzyme that is essential for human nervous system function. Researchers found that the Canadian diplomats had injuries in the networks of their brains that involve the brain stem, basal forebrain, and fornix. The specific types of injuries were “highly suggestive” of exposure to a ChE blocker.

The question now is whether Cuban nationals have also suffered brain injuries due to the pesticide campaign to stop the Zika virus. The researchers are working with Cuban officials to study this question.