Psilocybin for TBI–researchers hope to improve lives (7/15/21 newsletter)

Jul 19

This edition is brought to you by our summer 2021 Concussion Education & Advocacy Internship Program! This year, our internship cohort consists of 18 interns from 5 different colleges, four in the US and one in Ireland.

We would like to acknowledge our interns who wrote for this newsletter:

Writers: Clovis Wong, Karina Suwal, Meena Shanmugam, Alex Widman, Alyssa Schaechinger, Han Nguyen, Bethany Lazo, Calder Stenn, Aamy Woldesenbet, and Elizabeth Zhao.

Editors: Conor Gormally and Malayka Gormally.

These are the interns who wrote for this newsletter edition.

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Sports

Former British athletes share experiences with TBI

A recent article by an author from English law firm Bolt Burdon Kemp documented the experiences of two former British athletes involved in sports with high rates of TBI. Alan Smith, a former player for the soccer club Arsenal FC, discussed how head injuries are often overlooked in the sport, describing a personal experience in which he violently clashed heads with a teammate during training. “‘The coach encouraged me to carry on,’ he said, disappointed with the lack of intervention by medical personnel.” When asked about the FIELD study test, which found that footballers were “3.5 times more likely to suffer from a neurodegenerative condition,” the footballer expressed his concerns. “It must not be something swept under the carpet,” he responded, hoping for a fundamental change in the application of TBI protocol within football.

Skeleton bobsled athlete Eleanor Furneaux had a devastating run-in with TBI that ended her career at 24. She suffered two successive blows to her head in 24 hours, one directly preceding and another during competition, just weeks before the 2018 Winter Olympics. “Not once did it cross my mind that I should sit it down,” she recounted. Three years on, Furneuax is still struggling with the consequences of the injuries; she can no longer run without experiencing blurry vision or headaches and generally cannot participate in activities involving frequent head movement.

Both athletes feel that management of brain injury should not solely fall on the shoulders of athletes. The author shares the same sentiment, stating that “athletes are unlikely to perceive themselves as being at risk of concussion or are likely to dismiss a concussion as being a minor blow.”

Cannabis & Psychedelics

Research on psilocybin’s medicinal properties in traumatic brain injury treatment

UK- and USA- based branches of the nonprofit Heroic Hearts Project (HHP) are partnering with the Center for Psychedelic Research at Imperial College London to explore the psychological and physiological effects of psilocybin (magic mushrooms) on veterans with a history of TBI. According to an article on Canex, the observational study will take place at retreats run by HHP starting in Fall 2021. The UK branch will run retreats in the Netherlands, and the US branch will run retreats in Jamaica. HHP is prioritizing veterans who sustained head trauma during their service and veterans experiencing psychological difficulties. This study aims to produce measurable outcomes regarding both the psychological and physiological effects of psilocybin in TBI treatment. The researchers point out that much of the current research on psilocybin focuses exclusively on psychological outcomes.

The Heroic Hearts Research Director, Dr. Grace Blest-Hopley, hopes “to not only achieve the goal of helping our participants but also provide further evidence of psilocybin’s medicinal properties; particularly in the context of head traumas. We hope this will then act as groundwork for further research that ultimately could improve the lives of many in the veteran and non-veteran population who are currently suffering.”

Self-care

Coping strategies for executive dysfunction

The brain injury association Headway published an article on executive dysfunction following TBI. Executive dysfunction refers to the emotional, behavioral, and cognitive impairments which sometimes occur after a brain injury. Executive functions—including planning, motivation, and multitasking skills—are necessary for daily activities, and impaired executive function can lead to difficulty initiating and performing tasks.

Those with a history of brain injury might have trouble solving complex problems or lack the motivation to carry out involved tasks. People with executive dysfunction may also act impulsively or find it challenging to concentrate. Executive dysfunction can bring about feelings of frustration and strained relationships with others.

Fortunately, brain injury survivors can employ coping skills if experiencing impairments in executive function. For instance, individuals who have difficulty planning can use checklists to keep track of day-to-day activities and weekly calendars to divide plans into manageable chunks. Mentally rehearsing plans and discussing them with others can serve as an additional reminder of tasks that require completion. Moreover, cognitive behavioral therapy can help those who have trouble managing emotions due to executive dysfunction. People who find social environments challenging can benefit from mental preparation and reminders from trusted friends or family members of appropriate responses for certain social situations.

Therapies Currently Available

Targeted intervention improves symptoms in patients with mild traumatic brain injury with chronic symptoms

Mild traumatic brain injuries and their possible long-term consequences are major concerns for the US military. Shawn R Eagle et al. performed a prospective, multiple interventional research trial to assess how patients’ anxiety/mood symptoms, sleep quality, and vestibular/ocular symptoms improved after six months of active intervention in one of three clinical paths. The researchers also evaluated the effects of targeted treatments for these specific impairments.

A multidisciplinary clinical team divided the study’s 72 participants (average age 36.8; 19% female) into the following primary clinical trajectories, based on persisting mTBI symptoms: psychological (PSYCH; n=34), sleep (SLEEP; n=25), and vestibular/ocular (VESTIB/OCULAR; n=13). After receiving treatment in their specified clinical area, patients returned for a follow-up assessment six months later. Some assessments used during the follow-up were the Post-Concussion Symptom Scale (PCSS), Generalized Anxiety Disorder-7 (GAD-7), Pittsburgh Sleep Quality Index (PSQI), and Dizziness Handicap Inventory (DHI). Notably, the authors assessed the change in concussion symptoms and the primary outcome for each clinical trajectory.

Follow-up results showed overall significant decreases in anxiety, sleep, dizziness, and other concussion symptoms over the 6-month treatment. The study, published in the Journal of Special Operations, found that the targeted treatments for a given trajectory produced larger treatment effects than the overall sample, “indicating that targeted treatment can reduce symptoms in patients with mTBI who experience chronic symptoms.”

Some potential drawbacks in this trial are the small sample size and its limited diversity. The authors hope that additional trials with diverse samples, better representing the population, will contribute to the body of evidence for these kinds of targeted treatments.

Therapies Under Research

Researching brain stimulation to treat post-concussion headaches

According to a post from the U.S. Department of Veterans Affairs’ blog, Vantage Point, VA researchers have been investigating the effects of brain stimulation on post-concussion headaches. The VA researchers are studying various brain therapies that utilize electrical, magnetic or light stimulation. These are non-invasive therapies that provide an alternative to other headache treatments, such as pain-management medication or injections. TMS is a treatment that has been approved by the FDA for cases of major depression that don’t respond to other therapies and for pain due to migraine headaches (with aura)but has not yet been approved for treating brain injuries and PTSD.

Dr. Albert Leung, director of the Center for Pain and Headache Research at VA San Diego, is leading a trial to treat persistent headaches in active or retired military personnel through repetitive transcranial magnetic stimulation (rTMS). This rTMS treatment entails using large magnetic coils positioned over the desired brain area; these coils create fast and repetitive electromagnetic pulses to form a strong electrical current in the brain cells. Dr. Leung’s study will stimulate the brain’s motor cortex (the part of the cerebral cortex that helps with voluntary movements) and the dorsolateral prefrontal cortex (linked with memory and attention). This trial aims to have results by the end of 2023 as an extension to previous randomized controlled studies that demonstrated the short-term (one to two months) efficacy of the treatment.

Veterans interested in participating in Leung’s research can contact the study team at 858-210-8908. We recommend the 7-minute video about how rTMS works and what the patient can expect, produced by The Center for Pain and Headache Research. In terms of other VA brain stimulation research for post-concussion patients, read our blog post about the VA recruiting for a light therapy clinical trial.

Mental Health

Professional skier’s experience with brain injuries and mental health

In an essay published in Outside, professional skier Drew Peterson discusses his experiences with mental health issues after his head injuries. In 2017, Peterson was struck by a falling rock while skiing. Even though the large rock hit the back of his head, his upper back, and his left arm, Peterson managed to avoid death or devastating injury. However, he found himself struggling to live a normal life. “I felt like a ghost following my body around,” Peterson recounted.

Moreover, his belief that he had “cheated death” soon gave way to suicidal thoughts. In 2018, Peterson sustained more injuries. He had surgery following multiple shoulder dislocations; while exercising, he broke his collarbone and sustained a minor concussion. For Peterson, this was the breaking point: he needed help.

Peterson found help from a therapist. After being diagnosed with PTSD, Peterson felt that his emotional trauma and mental health struggles were validated. But when he started to feel that his PTSD was under control, he began to take more risks while skiing: in an accident, he sustained a severe concussion. Peterson was diagnosed with type-two bipolar disorder and post-concussion syndrome.

“Recovery hasn’t been straightforward,” Peterson writes. However, through therapy, meditation practice, medication, and lifestyle changes, he has successfully managed his mental health issues, even as they’ve been exacerbated by multiple brain injuries.

Youth

Youth athletes 14 years old and younger advised not to play contact sports in an attempt to reduce concussion risk

New Zealand news media Stuff covered new discourse surrounding concussion safety in contact sports, particularly for youth playing rugby. Though concussion prevention is essential for all ages, neuroscientist Dr. Chris Nowinski, co-founder of the Concussion Legacy Foundation, believes that children under 14 should not be playing contact sports. Dr. Nowinski is one of many advocates pushing the importance of extra safety measures to protect younger athletes from "repeated head knocks." There were 3000 ACC claims for concussion by rugby players in 2019 alone, 64% of the claims being made by players between the ages of 10 and 19. [The Accident Compensation Corporation (ACC) provides compulsory insurance coverage for personal injury for everyone in New Zealand.]

The article additionally mentions youth participation in Rippa Rugby–a non-contact version of the sport that "has mandatory stand-downs for concussed players."

The article mentions several former pro rugby players who are concerned they may have CTE. Dr. Nowkinski comments that rugby has "a very significant CT problem" and that other contact sports also pose potential risks. However, New Zealand rugby chief executive Mark Robinson remarked that it's "simply too early" to claim a definite link between concussions and CTE, claiming that "We need to do more research into those areas." Despite this more conservative take by Robinson, Dr. Nowinski stated that he has "seen CTE in people who've died as young as 17," as well as "people who stop playing sports at 13."

Women's Health

Finding the link between brain injury and its impact on behavioral symptoms could be beneficial for domestic abuse survivors

A report from The Disability Trust shared the practitioner’s perspective on the link between domestic abuse and brain injury. The Disability Trust is a UK-based charity that aims to provide help for individuals with autism, newly acquired brain injuries, and physical or learning disabilities. This report is the third in a series following a survey on brain injury and domestic abuse. Focusing on frontline staff who serve domestic abuse survivors, the report found that:

81% of frontline staff had no previous training in acquired brain injury
62% of respondents felt “mostly unprepared” to identify symptoms of brain injury
10% had heard of or used the Brain Injury Screening Index (BISI).

Strikingly, 48% of frontline staff believe that “less than 10% of the people they support may have a brain injury,” when research shows that 35% - 85% of domestic abuse survivors have suffered a TBI.

A problem brought up by many practitioners is that it can often be hard to identify a brain injury when working with domestic abuse survivors. This difficulty with identification is because many brain injury symptoms (both physical and emotional) overlap with other injuries and mental struggles that often occur in domestic abuse survivors. Solving this problem would require a connection to be made between brain injury and its impact on behavioral, cognitive, and emotional symptoms.

“More training is needed to better identify brain injury. For all of us to ask the right questions to better identify it.” -Survey Respondent

The report ends with a collection of recommendations for how to solve this problem going forward. Recommendations include further research, collaboration between experts, and training and awareness. The final recommendation is the development of sensitive and trauma-informed brain injury screening methods that are appropriate for use with domestic abuse survivors. Implementing these recommendations could be very beneficial for domestic abuse survivors who have suffered a brain injury.

Significant head injury among women in prison in Scotland–89% from domestic violence

A cross-sectional study published in The Lancet investigated associations between significant head injury (SHI) and persisting disability and violent crime in imprisoned women in Scotland. Background information provided by McMillan et al. includes the estimate that head injury affects as much as "55% of women in prison and might be a risk factor for violent offending, although evidence is 'equivocal.'"

This study's sample consisted of 109 female offenders from three prisons in Scotland and was demographically representative of the female offender population in Scotland. Participants completed a 90-minute assessment session, which included a demographic and background questionnaire. Researchers used the Ohio State University Traumatic Brain Injury Identification Method to assess reported head injuries and classify the participants into the SHI group and the no-SHI group.

Researchers defined significant head injury (SHI) as a "mild head injury with loss of consciousness for less than 30 minutes or moderate-to-severe head injury with loss of consciousness for at least 30 minutes, or head injury without loss of consciousness on more than two occasions."

McMillan et al. found that 78% of the women reported a history of SHI. Of this SHI group, 84% reported repeat head injuries, 89% reported domestic violence as the cause of injury, and 40% had associated disability. Additionally, significantly more women in the SHI group reported mental health difficulties than women in the no-SHI group. Also, "Women with a history of SHI were significantly more likely to have a history of violent offenses than those without a history of SHI."

The researchers conclude that there was a strong relationship between a history of SHI and violent crime in this population, suggesting that SHI needs to be incorporated into criminal justice policy and interventions for women.

Culture

Ending race-norming in NFL settlement of brain injuries suffered by former Black NFL players

Concerning its $1 billion settlement with players who have suffered brain injuries, the NFL has finally vowed to end race-norming, which involves the wrongful assumption that Black players have “lower cognitive function.” According to an AP article, the NFL’s commitment to ending race-norming came after NFL families filed a total of 50,000 petitions at Philadelphia’s federal courthouse.

Race-norming in the NFL has hindered many retired Black players from receiving financial compensation for long-term head injuries they sustained in the league. In the case of former Pittsburgh Steeler players Kevin Henry and Najeh Davenport, the NFL denied financial compensation for brain injuries they had suffered during their playing time. The two players claimed in a lawsuit that the NFL’s denial would not have happened if they were white.

“Race-norming” of neuropsychological exam results was developed in the 1990s for diagnosing dementia patients. According to an AP article published on the NFL website, “The binary race norms, when they are used in the testing, assume that Black patients start with worse cognitive function than whites and other non-Blacks. That makes it harder for them to show a deficit and qualify for an award.” The NFL has said that it did not require neuropsychologists to use race-norming for those applying for the NFL settlement money, but the “NFL appealed some claims filed by Black players if their scores were not adjusted for race."

Over 2,000 former NFL players have filed dementia claims resulting from brain injuries, and “more than 50% of NFL retirees are Black.” For NFL retirees who have received a financial award for dementia claims, the average payout has been upwards of $500,000, with players diagnosed with moderate dementia receiving more than $700,000 on average. However, less than 600 of the 2,000 retirees filing for financial compensation have actually received some form of aid. Retired NFL players can also appeal for financial assistance if they have Alzheimer’s disease and other brain-related issues.