Using helmets and mouth-guards to reduce concussion risk (2/6/20 newsletter)

Feb 8

We are pleased to have Carleton College students and alumni working with Concussion Alliance. Contributors this week:

Editor: Galen Moller
Contributors: Conor Gormally, Hannah Kennicott, Galen Moller, and Julian Szieff

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Education

VR software developed for concussion awareness

Shelby Brown recently wrote an article for CNET that covers “CrashCourse,” a VR software that allows participants to experience a concussion in a simulated high school football game. The free program, developed by TeachAids, is an educational tool for athletes that teaches them about concussion warning signs, diagnosis, and treatment.

TeachAids recently made CrashCourse available as a free download in the Oculus Store; the program is suitable for Oculus Go, Oculus Rift and Rift S. Concussion Alliance is now partnering with TeachAids to further our mutual concussion education efforts.

Sports

First data to confirm that youth football players are more vulnerable than adults

New data from Eamon T. Campolettano et al. finds that the average peak linear and rotational head accelerations associated with youth concussion are 62.4 ± 29.7 g and 2609 ± 1591 rad/s2, respectively. This is significant because these accelerations are about half of what is associated with adult concussion (102.5 ± 32.7 g and 4412 ± 2326 rad/s2, respectively) and are the first data ever to confirm that youth football players are more vulnerable to concussion than their adult counterparts.

Before this data was available, when researchers at the Virginia Tech Helmet Lab wanted to calculate how effectively youth football helmets reduced concussion risk, they would rely on data from high school, collegiate, and professional football players. But this study necessitates the “consideration of youth concussion as a distinct entity, and not just a scaled version of adult concussion.” In a news release from Virginia Tech, Dr. Stefan Duma explains that their data will allow them to “evaluate helmets based on the actual risks youth players experience.” The study is available from the Annals of Biomedical Engineering.

Cannabis

CBD-CBG combination could combat neuroinflammation

A study published in Medicina explores whether two non-psychoactive cannabinoids could reduce neuroinflammation. Santa Mammana et al. found that cannabigerol (CBG) enhanced the anti-inflammatory properties of cannabidiol (CBD) by inhibiting inflammatory response and enhancing the cell’s anti-inflammatory cytokines. CBG treatment on its own was not effective at reducing neuroinflammation, but CBD treatment was.

The authors believe that their results “provide preliminary support for the potential therapeutic application of CBG and CBD in motoneuron degenerative diseases.” While they focused on potential applications for ALS and other neurodegenerative diseases, their research is also relevant to treating inflammation stemming from a concussion.

Diagnostics

When to call the neuro-optometrist

In an article for Optometry Times, Dr. Melissa Zarn-Urankar, an assistant professor at the Southern College of Optometry, shares five exam findings that should spur a referral to a neuro-optometrist. For patients with a history of A/TBI, issues such as blurred vision, visual field defects, and eye movement challenges are common complaints. Crossed eyes can also occur after A/TBI but show variable incidence rates.

While some post-injury visual symptoms stabilize over time, others will “persist indefinitely if untreated.” Neuro-optometrists specialize in the kinds of visual symptoms associated with brain injuries and can help facilitate recovery. For more information and resources about vision therapy, visit our treatment page.

Therapies

New partnership to understand music therapy’s mental health benefits

A news release published on EurekAlert announced that The Health and Technology District, located in Surrey, B.C., Canada, has partnered with Music Heals and Simon Fraser University to investigate the neurophysiological effects of music therapy on mental health. The study will include “adults with mental health challenges due to post-concussion syndrome” and use functional MRI to track brain activity as subjects participate in music therapy. SFU professor and lead researcher Dr. Ryan D’Arcy says they are particularly interested in studying “emotions and mood related disorders that can occur in both children and adults, using functional imaging of neuroplasticity that occurs as a result of music therapy.”

Veterans

Mental health risks in veterans with a history of TBI

A new study published in Military Medicine by David L. Chin and John E. Zeber found strong correlations between TBI and mental health risk. With 4,980 service members and a 4-year average follow-up, this is the largest and broadest study of long-term mental health outcomes following severe combat injury. Despite narrower definitions for mental health disorders and strict exclusion criteria, service members with a history of moderate or severe TBI were up to 3 times as likely to have a mental health diagnosis, including post-traumatic stress, adjustment, anxiety, mood, and cognitive disorders.

In a news release from the University of Massachusetts, Dr. Chin explains that the prevalence of these disorders in soldiers without TBI is still very high, but their data shows that moderate or severe TBI has greater mental health risks. The authors note that this study is limited by their data, which only covers soldiers during their service. Lack of further follow-up and military culture of underreporting mental illness also suggests further research is necessary.

Mental Health

Concussion Alliance attends brain health summit focused on youth and mental health

The day before the Superbowl, Concussion Alliance co-founder Conor Gormally attended the 7th Annual Brain Health Summit in Miami. The event was hosted by the founder and president of Health & Human Rights Strategies, Nicole Fisher, and NFL agent Leigh Steinberg. This year’s summit focused on youth and mental health in relation to concussions.

Panelists included former NFL players Chris Borland and Julius Thomas, brain health experts Dr. Ross Zafonte and Dr. Natalie King, and Director of Miami-Dade County Juvenile Services Department, Maurice Copeland. The panel discussion, which is available online, focused on normalizing mental health as a part of wellness and treating brain-injury-related mental health symptoms alongside physical symptoms. In an article in Forbes, Lipi Roy, MD, MPH, discusses the 7th Brain Health Summit and the contributions of each panelist.

Statistics

Genetic variant associated with increased mTBI incidence

Insulin-like growth factor 1 (IGF-1) is a hormone shown to increase myelination, blood vessel growth, dendritic growth, and glucose uptake in the brain, and offer neuroprotection. Some studies have observed increased expression of IGF-1 in the hour following TBI, leading researchers to hypothesize that the hormone may play an immediate neuroprotective role. Building on this hypothesis, Yu-Jia Wang et al. analyzed five single DNA base pair differences in the IGF-1 gene to see if any of these genetic variants were correlated with a higher incidence of mTBI.

Comparing 176 mTBI patients to 1517 control participants, the research group found that one IGF-1 variant was significantly more common in mTBI patients than in controls. Dizziness and “multiple neuropsychiatric symptoms” were also correlated with this variant. The authors urge caution in interpreting these results but believe they merit further large-scale research into the prevalence and mechanisms behind these genetic differences. Their study was published in the Journal of Biomedical Science.

Women's Health

Elite female soccer players more likely to receive medical assessments than males

Compared to their male counterparts, elite female soccer players are around 50% more likely to receive an assessment following a head collision in a match, according to a study in JAMA by Christopher Tarzi et al. A report from the Canadian Press shares that the median time allotted to medical assessments was 70 seconds in women’s tournaments and 50 seconds in men’s tournaments, but “a minimum of 10 minutes is required to perform a concussion assessment.”

In the same report, one of the researchers, Dr. Michael Cusimano, said there could be a cultural component, as the referees at women’s games are women. He also suspects women may receive more medical attention because of the recent increase in media coverage surrounding women’s concussion rates. While these theories deserve further investigation, he concluded that “neither gender is really getting a passing grade.”

Culture

Changing understandings of football’s dangers

An article from The New Yorker reflects on the relationship between CTE research and the NFL, asking, “Exactly How Dangerous is Football?” Author Ingfei Chen weaves together opinions from researchers, parents, and medical ethicists with the history of scientific and societal understandings of football’s impact on the brain. She leads readers through the question asked increasingly by parents and players around the world: is it worth the risk?

The article focuses more on clearing away some of the confusion and conflict in the concussion conversation than answering that question. But its closing statements give some indication of the author’s thoughts: that “the perils of the sport now extend into the realm of the mind, pushing some former players into an irreversible fog of darkness and forgetting.”

Helmets and Mouthguards

Mouthguards for concussion prevention

The British Journal of Sports Medicine published a study suggesting that youth ice hockey players should be required to wear mouthguards. Dirk Chisholm et al. drew data from two prospective cohort studies of youth hockey players. They examined the mouthguard use among players who sustained a concussion and players who sustained a non-concussion injury. They found that across the board, mouthguard use was associated with lower odds of concussion.

They also compared off-the-shelf mouthguards to dental custom-fit mouthguards. Off-the-shelf mouthguards were associated with a 69% lower odds of concussion. Dental custom-fit mouthguards were associated with 49% lower odds of concussion, but the researchers say this finding is not statistically significant due to the smaller sample size. In a news release from the University of Calgary, researcher Dr. Brent Hagel says that they are still “in the early days of investigating the biomechanics of the specific types of the mouthguards that are best,” so further research is necessary.