How media affects us + important changes to the newsletter (1/9/20 newsletter)

Jan 19

New Year, New Newsletter

If you look at the title of this newsletter, you may notice it no longer says "Weekly Concussion Update." After much deliberation, we've decided that right now, the best way for Concussion Alliance to uphold its values for quality, reliability, and accessibility is for us to publish our newsletter every other week. This will enable us to give more attention to creating other useful resources.

So you'll hear from us a little less, but know that we are very grateful to have such a supportive readership, and we are still doing our best to bring you helpful and informative content, even if it isn't in the form of a weekly newsletter.

We hope you enjoy our first [biweekly] Concussion Update.

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

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

Do you find the Concussion Update helpful? If so, forward this to a friend and suggest they subscribe.

Education

CDC gives $2.2 million to Back to School program

According to the Daily Emerald, the University of Oregon’s Center on Brain Injury Research and Training (CBIRT) recently received a $2.2 million grant from the CDC, allowing them to study their Back to School program. The program was created to ensure the safety and reintegration of students into school after a traumatic brain injury, and focuses on identification of injury, communication between medical professionals and education professionals, symptom tracking, and “professional development for school staff.”

The CBIRT team will conduct research studies comparing schools in Central Oregon, which have the Back to School program, and schools in rural Ohio, which do not have a reintegration program. Using this data, the CBIRT team will determine future steps for the program.

Sports

Post-Impact Management of Rugby Players and Media Commentary Affect Concussion Identification by Viewers

A study published in the Journal of Head Trauma Rehabilitation focuses on how sports broadcasts influence public perception of concussions. 828 participants were shown 12 clips of professional rugby players experiencing concussion-like events and then asked if they believed a concussion had occurred. Researchers then measured concussion reporting behavior by giving the participants additional information about how the player’s injury was managed and asking them if they still agreed with their initial concussion assessment.

Authors Cindy Ku et al. found that viewers were more likely to change their initial assessment if it conflicted with how sports officials managed the player’s injury. If viewers learned that a player was removed from a game, those who initially thought there wasn’t a concussion were more likely to change their assessment than those who initially thought there was a concussion. Conversely, if viewers learned that a player returned to the game or stayed in following a head injury, those who believed there was a concussion were more likely to change their assessment than viewers who believed there wasn’t.

The results of the study demonstrate the power that televised sports have on how the general public views concussion-like events. If professional sports teams and sports broadcasters treat potential concussions more seriously and cautiously, the general public may be more likely to do the same.

Cannabis

EVALI update from the CDC

The CDC recently published an update on e-cigarette or vaping-associated lung injuries (EVALI) as part of their Morbidity and Mortality Weekly Report. Almost 2,300 patients have been hospitalized with EVALI as of early December; 80% of them report using devices containing. Vitamin E acetate is associated with these injuries, but there may be more than one cause of EVALI, so other substances and product sources are being investigated.

The CDC reports that among hospitalized EVALI patients, Dank Vapes was the most frequently reported product brands (used by 56% of patients). TKO (15%), Smart Cart (13%), and Rove (12%) were the next most commonly reported product brands. Dank Vapes produces empty-branded cartridges that are often filled by individual sellers with “counterfeit-THC products of unknown origin.” The CDC recommends avoiding e-cigarette and vaping products that contain THC–“especially those acquired from informal sources.”

While there have been studies showing the effectiveness of vapor pens containing CBD and THC for fast-acting symptom relief, it is important to recognize that not all brands are created equal. See our website for more information on CBD products from Marijuana.

Diagnostics

Research evaluates the impact of concussion on corpus callosum, but results require future confirmation

In December, the annual meeting of the Radiological Society of North America featured a presentation by Dr. Melanie Wegener and her team of NYU researchers about how concussions could disrupt the flow of information between the hemispheres of the brain. It is hypothesized that the bundle of nerve fibers that connects the two hemispheres of the brain, known as the “corpus callosum,” is more vulnerable to damage from concussive blows than any other brain structure, a LiveScience article explains. Doctor Wegener’s team explored this possibility using diffusion MRI to map activity levels in the corpus callosum of patients with and without TBI and then giving them a reading test that would require them to transfer information from the right brain hemisphere to the left.

They found that TBI subjects’ performance on the test was dependent on a different area of the corpus callosum than the non-TBI subjects. This led them to speculate that the concussions “likely altered the original structure of the corpus callosum, forcing words to find alternate routes across the brain.” Since Wegener’s research involved a distinctly small sample size, it is unclear whether the study’s results would apply to a different, larger sample of patients. But if other studies confirm Wegener’s results, physicians could “track structural changes in the corpus callosum” to improve diagnostic specificity regarding concussions and even use this technology to monitor neurological recovery over time.

Therapies

Seeking research participants: light therapy for persistent concussion symptoms

Researchers are recruiting participants for two studies to see if LED light therapy can improve thinking and memory in people who are experiencing persistent symptoms from one or more traumatic brain injuries (TBIs), including concussions and sub-concussions. The study is led by Margaret Naeser, Ph.D., one of the leading researchers on light therapy for the brain. Dr. Naeser’s studies on light therapy for TBI and post-concussion syndrome were recently mentioned in an article by the Telegraph, which discusses the current clinical trial using a similar Vielight headset device to treat Alzheimer’s. We covered the positive results of her two case studies of LED light therapy for persistent symptoms due to repetitive head impacts in retired pro football players in a recent blog post. See our page on Light Therapy for additional information.

Dr. Naeser is located at the Boston VA Medical Center and is a Research Professor of Neurology at the Boston University School of Medicine. Concussion Alliance recently published a blog post with information about the rationale behind the studies, eligibility requirements, and details about the two studies. Study participants should be within 100 miles of Boston. Contact Dr. Naeser’s office to inquire at 857-364-4029.

Veterans

Pentagon investigating long-term effects of mild TBIs from shoulder-fired weapons

A 2018 study by the Center for a New American Security, indicating that shoulder-fired weapons can cause small brain injuries that cause cognitive deficits over time, has compelled the Department of Defense to “study the effects of shoulder-fired weapons on the brain, and to document service members’ exposure for future reference and study,” Military Times reports.

The report also found that these injuries are often under-reported due to the stigma of invisible injuries. Warrant Officer Class One Mark Mortiboy, the New Zealand Defence Force’s senior enlisted advisor, explained that acknowledging unseen health problems is generally not encouraged in military circles. But he says ignoring them has “led to some pretty unsavory incidents, and poor decision making, bad target recognition.” Part of the study will involve framing brain injuries as an operational issue more than a medical one. If service members recognize that their cognitive health affects their performance, they may be more likely to admit when they feel something is wrong.

Mental Health

Baseline testing and life-stressors

At the beginning of each season, athletes often take baseline concussion tests, examining their neurocognitive function, balance, and whether or not they have any concussion-like symptoms. If an athlete gets injured, medical professionals can compare their pre-injury test performance to their post-injury performance, to determine if a concussion may have occurred. To ensure the accuracy of these tests, researchers J.D. DeFreese et al. examined whether life stressors might affect athletes’ performance and skew their preseason baseline results.

They had 123 college student-athletes complete the typical baseline tests and then assessed if their performances were different depending on whether they were experiencing high, moderate, or low life stressors. While participants with moderate life stressors performed significantly worse on a certain portion of the concussion baseline test than participants with low life stressors, the researchers found that “few baseline concussion assessment variables were found to be significantly associated with life stressors.” Therefore, existing psychological stress may not skew concussion evaluation. The study was published in the Journal of Sport Rehabilitation.

Statistics

More college concussions occur outside of varsity athletics

JAMA Network Open recently published a study that assessed rates of concussions in a relatively under-studied population: college students who are not athletes. The authors, John Breck et al., studied 954 undergraduate students who were diagnosed with at least one concussion during the academic years between 2014 and 2018, in addition to 80 varsity student-athletes who were diagnosed with a concussion in the academic years between 2016 and 2018. They found that non-sports-related concussions outnumbered sports-related concussions.

In the general student population (not including varsity athletes), only 36% of concussions occurred during organized sports, such as club sports. When data from varsity athletes was included in their analysis, the researchers found that sports-related concussion incidence was 51 per 10,000 students per year, while non-sports related concussion incidence was 81 per 10,000 students per year. They explain that research has given most of its attention to sports-related concussions, and this creates “an underestimation of the underlying incidence and prevalence of concussion in the general population and leads to the widely held perception that most concussions are sport related.”

Women's Health

A survey of sex-based concussion differences

An article by David Robson, published on Mosaic and republished by the Independent, highlights areas of research on potential differences in concussions for men and women. Robson discusses a study led by Dr. Angela Colantonio, that found that for all reported, non-severe concussions in Canada between 2002 and 2012, women had high rates of neck injuries than men. They were also "more likely to have a neck injury with concussions from motor vehicle crashes and from sports.”

Robson also refers to a 2013 study from the Journal of Head Trauma Rehabilitation that found a relationship between the menstrual cycle phase at the time of injury and symptom and cognitive scores a month later. This research has been continued, including in a study covered in our 10/10/19 Update Newsletter, where the authors hypothesized that estrogen and progesterone might have neuroprotective effects. In conjunction with his research summaries, Robson provides interviews of researchers, injured athletes, and advocates, creating a depiction of concussions that is both empirical and anecdotal.

Culture

Essay in digital health community shines a light on “setbacks” after TBI

In her essay “What a 'Setback' Means in My Life With a Traumatic Brain Injury,” Lisa Katharina articulates the difficult balance of living with post-TBI symptoms and how easily and randomly that balance can be disrupted. The essay, which was published on the digital health community platform "The Mighty", illustrates what a random, unforeseeable incident like getting “whacked in the head with a frisbee at the dog park” can mean for someone still sensitive to contact to the head.

Another important facet of living with post-concussion or post-TBI symptoms is dealing with setbacks like the one Lisa describes. Pre-planned measures, a solid support network, and a more in-depth self-care routine can help, but that physical recovery is only half the battle. Heightened isolation, frustration, fatigue, and pain are all part of a “setback,” and can affect a person’s mental health and physical health simultaneously. This essay reflects the experience of many of the people living with post-concussion symptoms and TBI, and hopefully can help others like Lisa feel less alone.