UK charity hosts first soccer game with heading restrictions (9/30/21)

Oct 2

Thank you for opening another edition of our Concussion Update! We know that your time and energy are precious, and we are so appreciative of all of our readers who take the time to learn about the latest and greatest in the world of concussion research, treatment, and culture.

If you want to see something we've been a part of recently, you can check out this recording of Concussion Alliance presenting for the AUT Traumatic Brain Injury Network's Repercussions Working Group, discussing how to rethink patient-centered research. Conor was one of four 15-minute presenters; his talk starts around 58:30.

We appreciate the volunteers and leadership team members who created this edition:

Writers: Lori Mae Yvette Calibuso Acob, Minhong Kim, Alyssa Schaechinger, Wyatt Hill, Chelsea Ryan, Conor Gormally, & Malayka Gormally

Editors: Conor Gormally and Malayka Gormally.

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Opportunities

Register by October 7 for the free University of Calgary Online Concussion Course.

Fall 2021: Love Your Brain is offering free, online interactive Mindset and combined Mindset & Yoga programs, starting this fall. They also have free in-person yoga classes starting soon in Colorado, Massachusetts, North Carolina, Utah, and Washington.

September 28 - November 16: four consecutive, free, online Awareness Training Programs for college faculty/staff on supporting Veterans and Military students. Session 4 covers TBI.

Sports

UK efforts to move away from heading in soccer on multiple fronts

This past Sunday saw the first-ever full-field adult soccer match with heading restrictions played in Spennymoor, County Durham, England. The teams consisted of current and former professional players, some of whom boasted English Premier League and even International experience. The first half was played with headers only legally allowed inside the 18-yard box, while in the second half, players were not allowed to head the ball in any situation.

Dr. Judith Gates, the co-founder of UK-based charity Head for Change, orchestrated the game showcase, which took place at the field where her husband, former Middlesbrough player Bill Gates, began his career. Dr. Gates hopes to raise awareness and stimulate research on the long-term effects of heading on players’ cognition and brain health, a paradigm that may be beginning to shift.

According to a BBC article about the Spennymoor town game, this “season professional clubs in England have been told to limit players to 10 ‘higher-force headers’ a week in training.” Additionally, the Tuesday before Head for Change’s awareness game, Scottish Labour MP Michael Marra received “cross-party support” for a proposed working group dedicated to investigating dementia risk associated with soccer and headers, according to an article in The Herald Scotland. Mr. Marra also called for further research into game safety for female players. Many factors make it difficult to effect wholesale change in rules and regulations for the world’s game, but these events indicate progress in the right direction.

Cannabis & Psychedelics

New CBD delivery system improves efficacy of cannabinoid treatments

A press release from Zelira Therapeutics describes a new CBD delivery system that considerably increases CBD uptake in animal studies. A Zelira-funded research team “created tiny capsules containing cannabinoids which, when taken orally, were absorbed by the body faster and penetrated the brain quicker in mice models with neurological diseases.” The researchers found that this delivery system improves CBD delivery to the brain by up to a factor of 40.

This technology also addresses CBD’s vulnerability to degradation and improves shelf-life, as the capsules protect the compound from degradation due to light exposure. With this improved delivery system, cannabinoid treatments have the potential to be more efficacious in treating a variety of neurological disorders, such as Alzheimer’s, multiple sclerosis, and traumatic brain injury.

Diagnostics

Wearable technologies and machine learning methodologies: the possible quantitative and high-precision diagnostic tools for mTBI

In a publication released by the Journal of Neural Engineering, William Schmid et al. review the potential of integrating wearable technologies and machine learning (ML) methodologies to increase mTBI diagnostic reliability. Wearable recording devices and ML approaches would constitute a meaningful development towards quantitative and non-invasive diagnostic systems for mTBI.

Presently, there are no widely available, objective measures to diagnose mTBI definitively. Despite the consensus of the definition of an mTBI, the varying physical, cognitive, emotional, and behavioral symptoms make it difficult to determine a set of consistent pathognomonic (specifically characteristic) signs to use in diagnosis. Thus, symptom-based protocols can be unreliable and are often expensive.

To combat this challenge, researchers evaluated the following non-invasive physiological biomarkers: EEG measurements of the central nervous system, cerebral circulation, ANS functionality, and physiological responses to changes in the formerly mentioned biomarkers. Wearable technologies quantify these biomarkers, recording bioelectrical signals such as EEG and ECG or converting biomarkers into electrical signals. This data is then sent to a smartphone or tablet, enabling frontline personnel, researchers, and clinicians to read and evaluate if an individual has mTBI-related impairments, even in the acute phase.

This approach provides a paradigm shift towards bringing reliable, objective data to clinicians and researchers to better understand the progression and symptoms of mTBI. Although more studies need to be conducted to evaluate this approach's effectiveness compared to typical symptom-based protocols, wearable technologies and ML methodologies hold promise and potential in the reliable diagnosis of mTBI.

Self-care

Showing support: 5 ways to help a friend who has suffered a brain injury

A recent article from Headway: the Brain Injury Association shares five ways to support a friend dealing with a brain injury. The first suggestion is to learn more about brain injury. Asking your friend about symptoms they are dealing with and suggesting helpful tips to deal with or mitigate these symptoms can make those with a brain injury feel like they have someone who truly cares about their recovery. Headway also mentions that it is essential to understand that fatigue often comes along with head injury, making it crucial to have patience with your friend as they recover. When you are out and about, remember that they may need to take breaks or even cut activities short and support them in their decision.

The next suggestion to help your injured friend feel supported is to encourage them to expand their support and care networks. It can often be hard for someone with a brain injury to notice the effects of the injury on their mental health, and having a friend encourage them to seek the help they need can aid in their overall recovery. Another helpful tip is to offer your friend the support that is most beneficial to them. For instance, if your friend has a pet, it may be a considerable help to offer to watch the pet to allow your friend time and space to recover. The final suggestion is to look out for your friend overall. A brain injury can be challenging for someone to cope with, and having someone in your corner can be a huge help.

For more information on supporting a friend following a brain injury or concussion, check out our blog on social support following youth concussion.

Therapies Currently Available

Athletes’ deficits in motor, postural stability after return to sport increase chances of musculoskeletal injury, dual task exercises may help

In a review article published in Sports Medicine, Jason M. Avedesian et al. provide a theoretical framework for observed increases in lower extremity musculoskeletal (MSK) injury risk in athletes who have returned to sport following a concussion. The authors note that a previous systematic review and meta-analysis found that “athletes with prior SRC [sports-related concussion] are at twofold greater odds for subsequent MSK injury compared with athletes without a concussive injury history."

Avedesian et al. postulate that this increased injury risk is due to subtle losses in fundamental motor and postural stability that present when athletes are cognitively challenged while moving in some way (dual tasks). Dual-task locomotion (movement) deficits have been observed at recovery and up to two months following return to sport, further exacerbated by more complex dual tasks.

The authors believe that these deficits may be due to an increase in the cognitive demand of basic motor and postural skills stemming from microstructural damage in several regions of the brain. Expressly, they point to observed integrity loss in the corpus callosum (coordinating communication between the hemispheres during walking), posterior cingulate gyrus (regulating attention and motor inhibition), and dorsal lateral prefrontal cortex (reduced efficiency of neuronal resources). They also note that “high anxiety and fear of re-injury is associated with greater symptom severity and postural impairment, indicating not only should cognitive-motor performance be monitored but also psychological status post-SRC.”

Avedesian et al. provide in-depth suggestions for rehabilitating autonomous motor and postural control with a multitude of different exercises and approaches. They also offer avenues for incorporating a cognitive task into the Buffalo Concussion Treadmill Test, the current standard for evaluating symptom exacerbation and orthostatic (exercise) intolerance.

Mental Health

mTBI is associated with a higher risk for subsequent affective disorders in adults

A study by Dr. Richard L. Delmonico et al., published in PM&R (The Journal of Injury, Function, and Rehabilitation), found that mild traumatic brain injury (mTBI) is associated with a higher risk for subsequent affective disorders (depressive, anxiety, and adjustment disorders) in adults. The researchers analyzed 9,428 adult patients diagnosed with mTBI and 18,856 controls matched for age, sex, ethnicity, and medical comorbidities.

Compared to controls, patients without a prior (pre-injury) affective disorder had 1.5 times greater odds (aggregated) of having an affective disorder after mTBI. Patients with a prior affective disorder had 1.2 times greater odds (aggregated) of having an affective disorder following mTBI. Depression and anxiety were the most prevalent affective disorders.

Interestingly, patients with prior history of affective disorders had a lower risk of having an affective disorder following mTBI, which may be because individuals with a history of affective disorders tend to have received mental health care in the past.

However, these results may not translate to the entire population. First, all participants in this study had integrated health insurance with more options for mental health care; thus, these results may not translate to groups without health insurance or with a health care plan with less coverage. Furthermore, because this study focused on the adult population, outcomes and incidence of affective disorders following mTBI in the pediatric population may differ.

Despite these limitations, this study does suggest that mTBI is associated with a significantly increased risk of developing affective disorders post-injury.

Youth

Parents’ observable stress about their child’s concussion may impact recovery times

In a paper published in Journal of Science and Medicine in Sport, Elizabeth F. Teel et al. conducted a mixed-methods study of the relationship between parental stress and recovery time for pediatric concussion. The authors surveyed 49 child-parent pairs reporting to a clinic for concussion (children aged 5-17). They combined that quantitative data with qualitative in-depth interviews from 12 of the parents at a later date (median 14 days after clinic visit and 26 days after injury).

Of the 49 parents, 28 had low stress levels at their child’s clinical visit, while the remaining 21 had moderate or severe stress levels. In their analysis, the researchers found that children whose parents were in the moderate/severe group took, on average, 14.5 days longer to recover – this difference was statistically significant. Further, their “results suggest that, at any given time, children with parents experiencing moderate/severe stress were 2.2 times less likely to be recovered and 1.9 times less likely to be discharged from clinic than their peers with parents experiencing low stress.”

Upon analyzing qualitative data from the interviews, Teel et al. also propose that the parent-child stress relationship is interdependent and bidirectional. “Parents believed their child observed them experiencing stress, which in turn caused the child to be more anxious about their recovery (stress moving from parent to child). Conversely, other parents noted that their children were experiencing high stress, causing the parent stress (stress moving from child to parent).” They note that clinicians should observe parents of pediatric concussion patients for signs of a high stress response and provide educational materials and resources to mitigate parental stress as early as possible.

The authors also note that moderate/severe parental stress may manifest in subacute and chronic phases of injury rather than the acute phase. This relationship requires further exploration and validation with larger sample sizes and greater nuance in exploring the differences between parental stress and parental anxiety.

Concussion Alliance highly recommends reading this study further (it’s fewer than five full pages), and synopsis author Conor Gormally will be publishing an in-depth exploration of its results and implications for parents and children on the Concussion Alliance blog. The blog post, once published, will also be announced in this newsletter.

Women's Health

Research to investigate the consequences of domestic violence on brain health

Dr. William Stuart, principal investigator of the 2019 FIELD Study of neurodegenerative mortality among Scottish footballers, will now take the lead to investigate brain health outcomes following domestic abuse. The Drake Foundation is supplying funding for this study, which will use data collected from the PREVENT Dementia Programme to evaluate changes in neuroimaging and cognitive test data within individuals exposed to domestic abuse. Using this information, they will be able to correlate and compare the data with population controls who have no reported history of abuse.

Lauren Pulling, Chief Executive of the Drake Foundation, stated in an interview with BBC that "This is a critical area of research. We hope that the Drake IPV Study will not only advance our knowledge of brain health in both IPV survivors and the general population, but also help to reduce the stigma around domestic abuse by bringing it into the open."