Why recovery is highly personal ( 1/23/20 newsletter)

Jan 25

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

Editor: Galen Moller
Contributors: Conor Gormally, Galen Moller, and Katie Taylor

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Education

New free concussion clinic at the University of Prince Edward Island

CBC News reports that the University of Prince Edward Island (UPEI) has opened a new concussion clinic at their Health and Wellness Centre in Charlottetown. The free clinic will be offered once a week for students, faculty, and staff. Gail Macartney, assistant professor in UPEI's Faculty of Nursing and member of the UPEI Concussion Awareness Program Research Team, says the intent is to ensure that “people who have had concussions return to their normal activities as seamlessly as possible.” She says they’ve already seen positive effects as more students are learning that they don’t need to isolate themselves and abstain from regular activity to recover (an outdated approach known as “cocooning”).

Sports

Brain volume changes in professional fighters

A study by Charles Bernick et al. and published in Neurology examined the effects of repeated head trauma on the volume of different parts of the brain. The study’s participants were active and retired professional fighters and controls drawn from the Professional Fighters Brain Health Study. Each year, subjects underwent 3T brain MRI, cognitive testing, and blood testing, which measured changes in brain volume, tau levels, and neurofilament light (NfL).

This study reported that active boxers showed significant volume decreases in the left thalamus and mid anterior corpus callosum. Retired boxers, on the other hand, showed significant volume decreases in the amygdala and the right hippocampus. The researchers say that one explanation of these results could be that young boxers, who are actively exposed to repetitive head impact, are losing volume in the thalamus and corpus callosum because of “accumulating axonal injury." The change in hippocampal and amygdala volumes in older fighters “may be reflective of a different process such as CTE or other types of neurodegeneration.” They acknowledge that their study has limitations. For example they were not able to observe many of their subjects for more than an average of 2.6 years. But their results demonstrate a need for further research into brain volume with repetitive head impacts.

Cannabis

Study shows cannabis use decreases symptom severity after a concussion

Read this synopsis in our blog post.

Diagnostics

How mTBI affects DNA and how DNA affects mTBI resilience

In a blog post for On Biology, Nicole Schwab and Lili-Naz Hazrati explain how DNA could influence susceptibility to the effects of mTBIs. Their study, published in Acta Neuropathologica Communications, assessed DNA damage and gene expression in 38 donated brains with a “chronic history of mTBI through involvement in contact sports.” Compared to brains without a history of mTBI, the brains with a history of mTBI showed more evidence of deficient DNA repair. Additionally, the researchers observed “chronic inflammation and genomic instability,” which are both characteristics of “cellular senescence,” a state in which cells permanently stop their normal cell division cycle. Senescent cells accumulate naturally with aging, but senescence can also be induced prematurely by DNA damage and is associated with neurodegenerative diseases.

The fact that the brains in this study showed signs of senescence suggests that inefficient DNA repair had allowed DNA damage to accumulate and induce senescence. These results imply "an individual’s ability to efficiently repair DNA damage might underlie whether or not they recover well from a concussion." The researchers say it’s important to note that DNA repair enzymes “are genetically variable and have different patterns of expression between individuals.” MTBI outcomes are likely specific to the individual, which means that in sports, for example, it may not be appropriate to use “one size fits all” prevention and treatment policies.

Therapies

Why it is important to seek concussion care as soon as possible

A recent study published in JAMA Neurology indicates that after a concussion, delaying a trip to the clinic likely delays recovery. The researchers, Anthony P. Kontos et al., told Medscape Medical News that among clinicians, there is a “general reticence” to treat concussed patients early after their injury, due to “perceptions that it may result in a prolonged recovery.” But their study, which examined recovery data from 162 young athletes, found that those who sought clinical care within one week of their injury recovered sooner.

They note that all the athletes “had similar impairments and similar recovery time after they had received initial clinical care.” Their results suggest that professional guidance greatly enhances the recovery process. Dr. Kontos explains that “earlier care with a trained clinician allows patients to begin behavioral management strategies involving physical and cognitive activity, sleep, nutrition, hydration, and stress management.” He adds that patients “should not wait for a week or more to seek care to see if things improve on their own; rather, they should seek care as soon as they can to enhance their recovery process."

Veterans

Department of Defense is now required to track blast exposure and concussive events

Military.com reports that the 2020 National Defense Authorization Act, which was signed into law last month, includes a provision requiring the Department of Defense to document troops’ blast exposures and medical histories. This information will help determine what benefits they are eligible for, and “inform future blast exposure risk mitigation efforts of the Department of Defense.” The health information they record will include a history of concussive events or injuries that require “a military acute concussive evaluation by a skilled health care provider," as these can lead to long-term mental and physical health problems for veterans.

Mental Health

Traumatic brain injury in the incarceration system

A pamphlet published by the Center for Disease Control (CDC) discusses the relationship between traumatic brain injuries and incarceration in the United States. According to the CDC, 25-27% of inmates report that they have experienced a TBI–a rate that is especially significant when compared to the 8.5% of the general U.S. population that reports a history of TBI. Women who were incarcerated for a violent crime and children inmates are both more likely to have a pre-crime TBI.

Head injuries can lead to difficulties within incarceration. Symptoms of brain injury (such as irritability and mood changes) may be misinterpreted as insolence and punished by correctional officers. The pamphlet shares suggestions made by criminal justice professionals and TBI experts to improve the situation. Correctional professionals in the system should be trained to identify TBI symptoms and behaviors in inmates with histories of TBI. Correctional facilities can also provide programs for inmates with a history of TBI after they are released from incarceration.

Statistics

Researchers examine broader cost burdens on parents caring for concussed children

A study published in the Journal of Pediatric Nursing contributes to the small but growing literature regarding the costs of pediatric concussion care. Janessa M. Graves et al. examined the monetary and nonmonetary costs parents face when caring for a child with concussion. While the sample size and nature of the study limit its applicability, the authors believe that their findings have helped establish a need for further research. The study’s 18 parents self-reported direct costs ranging from $0-12,500, and “faced challenges ensuring appropriate insurance coverage for services rendered, a process that required advocacy on the part of the family to ensure that they would not be charged for covered services."

Beyond the costs of medical care, parents also recorded indirect expenses related to care and transitioning back to school. Some parents drove up to 55 miles each way to treatment clinics, and 56% reported missing 1-4 days of work to care for their children. The concussed youths missed between one day and one month of school, leaving parents to arrange for care and tutoring (one of the reported indirect costs). The researchers observe that economic burden did not affect the care received or the recovery of children in the study. However, it did “contribute to increased parental stress,” which they argue is important “because increased parental stress may impact a child's psychological recovery following pediatric injury.”

Women's Health

The “desire to keep going” can prevent proper TBI care

In an essay for The Root by Christina Brown Fisher, Davine Manson shares how she sustained a traumatic brain injury at the hands of her ex-partner, and why her symptoms went undiagnosed for weeks after the assault. Her story, combined with input from experts on domestic violence and TBIs, illustrates why the connection between the two issues is so often overlooked.

Survivors of domestic violence rarely recognize that their symptoms are potential indicators of a TBI. Akosoa McFadgion, PhD., a social worker and director of Howard University’s Interpersonal Violence and Sexual Assault Prevention Program, says that female students and African American women (like Davine) are especially susceptible to this, because of their “desire to keep going,” which prevents many women from getting the TBI care they need.

Culture

U.S. soldiers flown to medical centers for potential concussions following Iranian missile strike on Iraqi base

Eleven soldiers stationed in Iraq at the al-Asad base reported concussion symptoms after Iranian missiles struck the base on January 8th. USA Today explains that it was initially reported that there were no injuries from the strike, but “in the days following the attack,” the soldiers were flown to medical centers in Germany and Kuwait for further screening.

The Washington Examiner cites a military source claiming that the soldiers “initially seemed healthy,” but later reported concussion symptoms necessitating further screening. While the official statement included that the troops had been treated for concussion symptoms and flown out of Iraq, there is no official update on the health of the soldiers.