New tech for TBI care and prevention (9/19/19 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: Eloïse Cowan, Galen Moller, and Julian Szieff.

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Education

Groundbreaking online clinical guidelines for pediatric concussion diagnosis and care

A groundbreaking online service has launched to help healthcare professionals who are treating youth (ages 5-18) with potential or diagnosed concussions. The Living Guideline for Diagnosing and Managing Pediatric Concussion is the product of an international team of 50 experts, including clinicians and researchers, in the concussion field. They worked for three years to evaluate hundreds of scientific studies, from which they synthesized a series of best-practice clinical guidelines. As discussed in Ottawa Citizen, the experts will review new research on a monthly basis and regularly update the online guide. The website also has resources for families, schools, and sports organizations; it also suggests that people bring the Living Guideline to the attention of their healthcare providers. One of the main takeaways is that youth should not be limited to a dark room and prolonged rest after a concussion. The project was spearheaded by the Ontario Neurotrauma Foundation, but it is applicable worldwide.

Sports

Rutgers University joins multi-institutional traumatic brain injury research collaboration

Rutgers University has recently joined the Big Ten Ivy League Traumatic Brain Injury Research Collaboration. This collaboration is a research effort that studies the effect of TBIs in athletes, to improve prevention, detection and treatment of TBI for all citizens. The multi-institutional partnership increases access to the sports concussion data registry for all 18 institutions, while also increasing collaboration between researchers, athletes, and physicians. Rutgers has already begun collecting information for each injured athlete and continues to contribute to the six year data collection. The vast population sample should become a major player in concussion research, allowing for longitudinal studies on the impact of head injuries and will promote safer play.

Cannabis

New molecular technology provides faster CBD uptake

Researchers with the German biotech company, BioTeSys, and Ulm University, have developed a new molecular technology that allows for quicker absorption of ingested CBD, the non-psychoactive component of the cannabis plant. According to Project CBD, ingested CBD only dissolves in fat, so it does not absorb well from the large intestine if there is not already fat in the stomach. CBD absorption is much faster and more effective when the correct molecules are present to break down the fat.

In a study published in Molecules, authors Katharina Knaub et al. found a way to use a molecular system to help CBD to dissolve in water. These molecules break down the clumped up CBD into small spheres, which leads to faster and more complete uptake. This also means the effect of the CBD wears off sooner, because it is processed more quickly.

This new delivery mechanism for CBD offers a more effective and rapid treatment option for those who can’t or prefer not to use vaporizer pens. Concussion Alliance would like to point out that some CBD tinctures are infused in an oil, such as MCT oil.

Diagnostics

New MRI technique shows the danger of repeated impacts

Researchers at Stanford University and Trinity College Dublin are looking at how we can detect brain damage in mTBI. Eoin O’Keeffe et al.’s study in the Journal of Neurotrauma recruited MMA fighters and adolescent rugby players and examined their brains. The MMA fighters were given a contrast-enhanced MRI before a fight then tested 120 hours post competitive fight and this data was compared against impact data from mouthguards worn during the fight. The rugby players were examined pre- and post-season. In both groups, the number of impacts was correlated with the amount of disruption found in the blood-brain barrier (BBB). This disruption of the BBB was detected using a new MRI technique called DCE-MRI which measures fluid flow across the barrier. According to the research group, this suggests that this BBB damage is related to repeated impacts, not single impacts which could be more symptomatic.

Their work is part of a long-term study which hopefully should yield even more details about brain damage in contact sports. We also recommend the article Stanford Medicine News Center, “preliminary evidence of damage to the brain’s protective barrier in adolescent and adult athletes even if they did not report a concussion.”

Therapies

Specialized optometrists should be on the healthcare team

Optometrists should be on the healthcare team for patients recovering from a TBI, according to two posts published in Helio. Specialized optometrists can identify more serious eye problems; guide vision rehab; and prescribe specialized lenses, prisms, and tints/filters which may improve vestibulo-ocular function (balance and vision).

Curtis R. Baxstrom, OD, FCOVD, FAAO, FNORA, states:
“At a minimum, I would like primary care optometrists to be aware that patients with visual-vestibular dysfunction after TBI may need adjustments to their vision correction. They will typically do better with single-vision lenses for far and near. Progressive lenses or bifocals introduce motion in the periphery, which is very challenging post-TBI.”

In a second post, Michael S. Cooper, OD, writes that even head injuries in the past can create long-standing vision problems, eye discomfort, and dry eye symptoms.

Veterans & Service Members

Beekeeping helps veterans find jobs and peace

An article in The Washington Post reports on the rise of veteran-targeted beekeeping programs across the country. While some of the programs are intended as occupational training, other programs, such as Bees4Vets in Nevada, aim to help veterans who are suffering from PTSD and/or TBI. While there is not any hard evidence of beekeeping’s benefits, many of the veterans in beekeeping programs have reported that it gives them a sense of purpose, and helps them to focus and relax, and researchers are beginning to investigate if beekeeping could have therapeutic benefits for veterans with mental health issues. The University of Nevada, Reno is partnering with Bees4Vets to see if veterans in the program show improvement, and whether beekeeping is the cause.

Mental Health

Researchers use new technology to study late-onset neuropsychiatric symptoms from TBI

Many postmortem studies have revealed that tau depositions in the brain are linked to traumatic encephalopathy syndrome (TES), which are the late-onset neuropsychiatric symptoms that arise in patients who were exposed to mild-repetitive or severe TBI. New PET technology has allowed Takahata et al. to map out the depositions of tau in the brains of living patients with a history of either severe or mild-repetitive TBI, to better understand the associations between tau and TES.

In general, they found that subjects with a history of TBI had more tau in their neocortical grey and white matter than healthy control subjects. They also found that among TBI patients, those with TES had more tau in their white matter than those without the syndrome, and that the amount of tau in their white matter correlated with the severity of their psychosis. The study was published in Brain.

Statistics

New research deems side impacts to head as dangerous as frontal collisions

Irish Tech News highlighted new research from NUI Galway and University College Dublin concluding that injuries caused by side impacts to the head can be as dangerous as whiplash from frontal impacts. The research led by Dr. Valentina Balbi, and published in Soft Matter, simulated the effects of forceful collisions on the human brain through torsion tests on porcine tissue and modeling. They found that rotational accelerations, which are as likely to occur as frontal impacts, cause stretches and strains that impair neurons, lead to concussion, and even cause permanent damage.
These results are important, considering that collisions in football and boxing often cause axial rotations of the head. While research has often looked at the danger of frontal impacts, future studies may lead to changes in sports gear and practices to avoid the dangerous twisting motion of the brain.

Women's Health

An invisible injury leaves a dramatically visible mark for a 24-year-old lead writer

Jennifer Sherman, guest writer for Huffington Post, wrote a moving story of her experience with concussion. I Got a Concussion and It Derailed My Whole Life starts with her high-powered job in Berlin at age 24, and then a long journey recovering from a concussion she suffered on a bus. Four months after her injury, she writes with wisdom and perspective:

“Before I continue, I’d like to point out that my concussion journey, while traumatic and tough in its own right, has been padded by privilege; my work benefits gave me medical insurance and paid leave, and I was able to travel to see specialists. I’ve had access to treatments ranging from neuro-optometry and acupuncture to functional neurology, from physiatry and physiotherapy to reiki energy healing, and I am well aware that most of the millions experiencing concussions each year will not have the same, or even similar, opportunity. That’s a problem.”

Culture

From football star to investor: Richard Sherman funds concussion treatment companies

CNBC news source recently highlighted investments made by 49er’s cornerback Richard Sherman in concussion prevention. Sherman is currently anticipating his future after the NFL by supporting tech companies and start-ups. He continues to play a role in increasing player safety by investing in Vicis football helmets and Oxeia Biopharmaceuticals.
Oxeia Biopharmaceuticals is currently developing a pill that would aid with the brain’s response to concussion and help mitigate lasting effects. While the company is still at Phase 2 with the FDA, Sherman hopes to promote the medication for future victims of concussions in the industry.