TikTok 'Skullbreaker Challenge' causes TBIs (3/5/20 newsletter)

Mar 6

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

Editor: Conor Gormally, Malayka Gormally, and Galen Moller.
Contributors: Conor Gormally, Julian Szieff, Katie Taylor, Eloïse Cowen, and Malayka Gormally.

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Education

What a coach can do to prevent concussions in youth sports

The International Concussion Society (ICS) recently released recommendations for how youth sports coaches can take an active role in concussion education and detection. Many youth concussions aren’t recognized, and players continue to play at tremendous risk. The importance of these measures becomes very clear in the light of the CDC’s finding that 4/10 players say their coaches were unaware when they had concussion symptoms.

There are a few easy steps for coaches to take to reduce this risk. The ICS recommends first holding a team meeting to educate players on the signs and symptoms of concussions, as only 10% of concussions involve a loss of consciousness, and reminding players that as a coach you support them coming forward when they have symptoms. Secondly, the ICS recommends asking parents to act as Safety Officers surveying the field of play and conducting concussion checks established by the Mayo Clinic. Both of these recommendations should also be backed up by educating the team and league parents on concussions and remind everyone that, as a coach, your job is also to support them and ensure that players are safe.

Concussion Alliance would like to point out that the Mayo Clinic “Concussion Check” protocol relies in part on the use of the “King-Devick Test in association with the Mayo Clinic.” This is an iPad based test that is licensed by the Mayo Clinic and costs $20 per team member. Many concussion experts recommend that non-medical people use the free Concussion Recognition Tool 5 or the CATT Concussion Pathway to evaluate for a concussion. Both of these evaluation tools are essentially a series of questions that create a decision tree; they can be downloaded and printed out to bring to the athletic event. You can also download a pocket-size version of the Concussion Recognition tool. See our article Guidelines for Recovery for more information.

Sports

Virtual reality and clinical research combine to examine concussions in student-athletes

Penn State has undertaken a multi-year, interdisciplinary research project to determine the consequences of head acceleration events on brain development. Led by Semyon Slobounov, PhD, the project collects information about cognitive measures and blood-biomarkers in collegiate football players during football seasons. The researchers make use of virtual reality helmets with accelerometer monitors for assessments of orientation, immediate memory, and concentration. Already preparing to analyze data collected during the past year, Slobounov and colleagues hope to both reduce the frequency of injuries in student-athletes and to contribute to the growing interest in the link between concussions and neurological disorders.

Cannabis

Ingested CBD absorbance is affected by the contents of the stomach

CBD’s use for various diseases and injuries has been known to be affected by the contents of the stomach, particularly the amount of fat when taken orally. Researchers from England’s GW research group, specializing in cannabinol medical research, conducted a study comparing 30 patients who ate one of five different meals (high fat, low fat, milk, alcohol, and none) before ingesting a large CBD dose (750mg).

The patients who had eaten a meal high in fat before taking CBD had an absorption approximately four times higher than the fasting participants. Meanwhile, the low-fat meal patients absorbed triple the CBD of a fasting patient. Compared to fasting, all eating groups showed greater CBD absorption into the system over time, as well as higher maximum levels of CBD in the blood. Smaller increases in CBD absorbance also occurred with the whole milk and alcohol conditions. However, there was no difference in the time to reach maximum CBD blood concentration between patient groups. The researchers noted a high degree of variability between subjects, as well as dizziness, headache, and sleepiness in the group that had alcohol as a meal (5 standard drinks).

Diagnostics

New concussion screening tool for clinicians

A study published in Neurosurgery found that the new Concussion Clinical Profiles Screening tool (CP Screen) is as valid as other “commonly used concussion assessment tools” used by clinicians (PCSS, VOMS, and ImPACT) while providing more specific information that will “inform better clinical care.”

The lead author, Anthony Kontos, PhD, discussed the benefits of the 5-minute screening tool in an interview published in Medical Research. When we ask more specific questions- such as “Do you have a headache in the morning?” or “Do you have a headache after physical activity?” instead of simply, “Do you have a headache?” we can identify different concussion symptom profiles that can help guide more effective, targeted treatments. These more specific symptoms items will also enable clinicians to track symptoms and recovery across five profiles- anxiety/mood, cognitive, migraine, ocular, vestibular- and two modifiers- sleep and neck.

Therapies

Effective virtual reality therapy for pain management

In an article published by the New York Times, several researchers discuss the use of virtual reality (VR) as a supplemental therapy to treat and manage both acute and chronic pain. The article highlights that VR immerses patients in an alternate environment, enveloping the patient’s senses in a situation differentiated from reality. As opposed to merely watching television, playing with a toy, or reading a book, when a patient is using VR, pain messages sent by the nervous system to the brain are met with a “busy signal.” According to Dr. Hoffman, a virtual reality researcher at the University of Washington, VR can additionally be used to help patients strategize their pain management. He states, “Using VR as an adjunct, we can teach coping skills, techniques patients can use on their own that will help diminish chronic pain.” It is important to note that this type of therapy cannot stand alone; it should be used as an adjunct treatment to medication and other types of medical care.

This mechanism can be useful for many different types of chronic pain, but Concussion Alliance believes it could be especially valuable in the context of concussion recovery, as headache is highly prevalent with concussion, particularly for those with chronic symptoms.

Veterans

Duke study shows flaw in modern military helmets, lack of improvement in blast protection

In a study published in PLOS ONE and covered in Popular Mechanics, researchers at Duke University tested the primary wave blast protection of historical (WWI) and modern military helmets. Eynde et al. simulated overhead blasts with a shock tube and measured the impacts on helmeted and unhelmeted dummy heads. The researchers found that, while all helmets provided significant blast relief compared to no helmet, “the modern variant did not provide more pressure attenuation than the historical helmets.”

Despite significant progress being made in the ballistic protection capacities of modern helmets, it seems that modern military helmets have not been designed with blast wave reduction in mind. However, the solution to helmet design may be a matter of geometry and material. The French ‘Adrian’ helmet, designed to protect soldiers from overhead artillery impacts in World War I, “showed a significant decrease in pressure [on the crown of the head]” compared to the modern and other historical helmets, which were not statistically different from each other. Eynde et al. believe that the difference in crown pressure may have been due to the Adrian’s “deflector crest,” a ridge that runs along the top of the helmet and may help deflect the shockwave off the sides of the head. The authors point out that improvements in ballistic protection do not necessarily improve blast protection, so they are advocating for further study in material layering and helmet geometry to help better protect soldiers’ brains.

Mental Health

Study finds functional and symptomatic connections between sleep deprivation and anxiety

Concussions, and especially persistent post-concussion symptoms, are risk factors for anxiety, depression, and sleep problems. The Mayo Clinic’s page on post-concussion syndrome lists anxiety and insomnia among its symptoms, symptoms which can significantly affect patients’ quality of life. However, a recent study published in Nature & Behavior finds that even a modest reduction of time spent in the deepest stage of sleep, non-rapid eye movement (NREM) slow-wave sleep, has an impact on next-day anxiety. Simon et al. emphasize that their findings do not “invalidate the bidirectional nature of the interaction between sleep and anxiety.” Instead, they suggest that both directions of interaction (anxiety causing difficulty with sleep, and sleep deprivation increasing anxiety) have the potential of creating a “negative feedback loop” of sleeplessness and anxiety.

Simon et al. found that participants without sleep had 30% worse anxiety scores, compared to no change in those who had slept. In a post-experiment fMRI, they found, in sleep-deprived participants, decreased activity in the medial prefrontal cortex (which regulates emotion), and increased activity in the “emotion generation regions” of the dorsal anterior cingulate and amygdala. Further, they found that increased NREM slow-wave sleep was predictive of decreased anxiety and increased emotional regulation the next day.

Statistics

Controversy among neurologists: the case for TBI as a risk factor for dementia

Dr. Eric E. Abrahamson, a researcher at the University of Pittsburgh, recently suggested that dysfunction of the blood-brain barrier (BBB) after injury may be vital to understanding severe or mild repetitive traumatic brain injury (TBI) as a risk factor for dementia. The BBB is responsible for maintaining the brain’s plasma composition and protecting it from solutes circulating in the blood. Abrahamson’s review, published in Experimental Neurology, explains that sustaining TBI can cause changes in the permeability of the BBB, resulting in the influx of immune cells, leakage of serum proteins, and the accumulation of molecules known to play a role in neurodegenerative diseases. His focus on the buildup of pathological protein aggregates could elucidate the relationship between TBI and dementia risk.

Abrahamson recognizes that further research is necessary to legitimize the relationship between pathological mechanisms and TBI as a risk factor for dementia. Other neurologists studying this topic, such as William B Barr, are concerned by the numerous knowledge gaps in the field. In Archives of Clinical Neuropsychology, Barr argues that while studies such as Abrahamson’s have demonstrated a positive risk factor between TBI and the development of dementia, many studies obtain unclear results or use inconsistent research methods. Inaccurate characterization of dementia is one of many causes of the poor definition of the studied relationship. The consensus among neurologists remains that further investigation, potentially through longitudinal and human studies, is crucial before any causal association can be established.

Women's Health

Retired English soccer player blames dementia on heading

Following a study's finding that retired professional soccer players are three and a half times more likely to die of dementia than the general population (1.7% vs. 0.5%), Sue Lopez became the first retired soccer player to blame her dementia on heading the ball publicly. In an article published by the BBC, Lopez pushes for a heading ban for young players. Lopez spent the majority of her nineteen-year career playing for Southampton. Now, at age 74, she has dementia. While there has been an impressive amount of research on brain injuries within American football, the research on female concussions in contact sports is still limited. However, there is evidence that females sustain concussions more easily and have more severe symptoms. When BBC reached out to the twenty English Premier League teams about bans on youth heading, AFC Bournemouth was the only one to confirm its adoption of a ban. The Scottish Footballing Association has also instituted a ban on Under-12 heading beginning this February 2020.

Culture

Viral social media game, the TikTok 'Skullbreaker Challenge,' causes head injuries in youth internationally

A game that has gone viral on the social media site TikTok has caused brain injuries throughout South America, the United States, and Europe. The TikTok ‘Skullbreaker Challenge’ involves three young people doing a side-by-side contest to see how high they can jump. When the person in the middle jumps, the two on the side then kick the legs out from underneath the unsuspecting person in the middle, who frequently lands on their head. Young people have suffered concussions (and more severe head trauma), neck, and spinal injuries from Arkansas to England. All these assaults are online on TikTok, as part of the game is to post these video “challenges.” In New Jersey, two middle-schoolers have been charged with “third-degree aggravated assault and third-degree endangering an injured victim,” according to an article by PBS WHYY. An article in heavy. traces the origins of the viral TikTok challenge to South America, and includes anguished social media posts by parents describing what happened to their children.