Effective, low-cost online cognitive rehabilitation (9/2/21 newsletter)

Sep 5

We hope you had a good summer. We took the last week of August off, and with today's newsletter edition, we are back on a biweekly publication schedule. Several of you sent kind words of appreciation for this newsletter–thank you.

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

Writers: Lori Mae Yvette Calibuso Acob, Malayka Gormally, Minhong Kim, Alyssa Schaechinger, and Aamy Woldesenbet.

Editors: Conor Gormally and Malayka Gormally.

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

Our lead story, "Effective, low-cost online cognitive rehabilitation" is in the Veterans & Service Members section.

Opportunities

September 9, 11 am EST: Using Apps to Develop Executive Function Skills, a free webinar hosted by the International Paediatric Brain Injury Society. Register in advance.

September 13 - November 8: Free, non-credit, University of Calgary Online Concussion Course; we highly recommended the course. See our Education section for more information.

Call for study participants - service members & veterans experiencing insomnia

A clinical trial is enrolling service members and veterans to test the efficacy of an online Cognitive Behavioral Therapy app for insomnia (SHUTi), customized specifically for military members. The study is online; active duty service members ages 18-64 who are experiencing insomnia and have had a head injury may be eligible to participate.

Contact the study authors via email at cnrm-ecbti@usuhs.edu or call or text (301) 456-5474; researchers are closing enrollment at the end of September. The clinical trial is being run by The Center for Neuroscience and Regenerative Medicine at the Uniformed Services University.

Education

Free, seven-week online concussion course

We are pleased to announce that the superb University of Calgary Online Concussion Course begins on September 13. The course is a free, non-credit, self-paced course “for those who are interested in preventing, detecting, and managing concussions.” The last day you can register for the course is October 7 – you must finish by November 8.

Each module includes slideshows and video presentations by leading experts in the field, and forums to engage with fellow students and instructors. Thousands take the course in each iteration; students include “health professionals, sport coaches and teachers, parents with children in sport, sport leaders, and athletes.” The course is co-sponsored by the Université Laval; a certificate of achievement is available for $50 (Canadian) after you complete the course.

Sports

Athletes with a history of concussions may show altered brain microstructure and cerebral blood flow

Neurology published a study suggesting that college athletes with a history of concussions (HOC) showed greater declines in cerebral blood flow (CBF) and altered brain microstructure in two brain regions compared to athletes with no previous HOC. In an article in Medpage Today, one of the researchers, Tom Schweizer, said, “We found even though there was no difference in symptoms or the amount of recovery time, athletes with a history of concussion showed subtle and chronic changes in their brains.”

The study examined 228 college athletes, divided into two groups. The first group included 61 athletes with an uncomplicated concussion, 36 with a HOC. The researchers imaged this group five times between the acute phase of injury and one year post return to play. The second group also underwent the same imaging; this group consisted of 167 normative controls, and 73 had HOC.

Researchers Nathan W. Churchill et al. focused on CBF in two areas of the brain vulnerable to concussions: the cingulate cortex and the splenium of the corpus callosum. The cingulate cortex is composed of gray matter that coordinates sensory and motor skills. The splenium of the corpus callosum is a “bandage” that links the right and left hemispheres of the brain, ensuring that both sides of the brain can communicate and send signals to each other.

Researchers found that athletes with HOC had “subacute and chronic effects on cingulate CBF and callosal microstructure.” Researchers also discovered that athletes with HOC had microstructure changes in the splenium of the corpus callosum not present in the controls.

Despite the limitation that the study included self-reported concussion history, these findings suggest that athletes with HOC should be monitored closely as “subtle brain changes may be worsened by repeated injury.”

Cannabis & Psychedelics

CBD treatments induce improvements in moderately severe TBI

A study published in Experimental Neurology looked at cannabidiol (CBD) dosing for patients with moderately severe traumatic brain injury. Generally, we only cover research concerning mild traumatic brain injury (concussion), but we thought this study was interesting. The researchers L.K. Friedman et al. “infused CBD into a gelfoam matric forming an implant, then applied over the dura at the contusion site as well as delivered [CBD] systemically via injection.”

They found that the treatment reduced lesion volume and restored vestibulomotor performance (as measured in the beam-balance test) 12 days post-injury. Cognitive function was also improved as measured by the object recognition test.

Paid CBD study calling for study participants

Although not related to concussion, readers might be interested in participating in a paid CBD study by Validcare. This is a “study on oral hemp products and liver function,” and if you are eligible you will receive 30 days of CBD product at no charge and $100 for completing the study. ProjectCBD, a reputable nonprofit in the CBD sphere, has written an article about the need for the Validcare study. Concussion Alliance has no affiliation with Validcare. We suggest reading our page on Safety Information and Contraindications for CBD and Marijuana.

Self-care

Sleep disturbance, fatigue, and cognition, and the implications for mTBI patients

A recent study conducted by Jacqueline Anderson et al. took a close look at pathways that may impact cognition in mTBI patients. Notably, it examined the relationship between sleep disturbance, fatigue, and cognition in adults with mTBI using a prospective observational model.

The experimental group consisted of 60 otherwise healthy adults collected and assessed for sleep quality eight weeks after mTBI diagnosis. The researchers used two prominent sleep metrics, the Pittsburgh Sleep Quality Index and the Multidimensional Fatigue Inventory, alongside measures of speed of information processing, attention, memory, and executive function.

Study results showed an association between sleep disturbance and cognition, along with one between fatigue and cognition. Notably, more significant sleep disturbance was consistently correlated with poorer cognitive function. Associations between processing speed, attention, and memory, were also present in the study but were most consistently apparent on measures of executive function. The study was published in Neuropsychological Rehabilitation.

These early results may point to a link between mTBI and cognition through sleep disturbance and fatigue. Minding these initial findings, mTBI patients can take early steps to ensure that they routinely practice healthy sleeping habits, such as managing their sleeping environment and making lifestyle choices conducive to good sleep hygiene. A recently created page by Concussion Alliance takes a closer look at sleep and sleep-related problems and may serve as a resource for those with mTBI encountering such symptoms.

Therapies Currently Available

Targeted vestibular rehabilitation significantly helps adolescents with symptoms such as dizziness
For adolescent concussion patients with vestibular symptoms (such as dizziness, nausea, and headache), a four-week targeted vestibular rehabilitation intervention significantly improved outcomes compared to stretching, physical activity, and behavioral management strategies. The study by Anthony P. Kontos, PhD, et al. was published in The Journal of Pediatrics.

In a double-blind, randomized controlled trial, adolescents (12-18) within 21 days of a concussion with vestibular symptoms were assigned to either a vestibular rehabilitation or a control group. The vestibular rehab group was “prescribed precision vestibular rehabilitation exercises,” which they did at home for thirty minutes per day for four weeks.

The control group was instructed to do thirty minutes per day of “stretching/physical activity (e.g., walking, stationary cycle)” for four weeks. The control group was also given behavioral management strategies relating to “sleep, hydration, nutrition, stress management.”

Fifty study participants completed the protocol. The vestibular rehab group improved significantly on the Vestibular/Ocular Motor Screening test (VOMS), compared to the control group. Specifically, the vestibular rehab group improved significantly on the horizontal and vertical vestibular-ocular reflex but not on visual motion sensitivity.

This video demonstrates the VOMS test and includes explanations of the tests mentioned above. See our page on Vestibular Therapy for more information, including how to find a vestibular therapist. Our Find Providers page has additional information; see the section on “Physical Therapy and Vestibular Therapy.”

Post-mTBI, a self-administered, commercially available, low-cost computerized cognitive training program produced significant cognitive function improvements

See our blog post about this study.

Veterans & Service Members

Post-mTBI, a self-administered, commercially available, low-cost computerized cognitive training program produced significant cognitive function improvements

See our blog post about this study.

Youth

The link between post-concussion transitory kinesiophobia (fear of movement) and reaction time: A prospective cohort study

A recent study in the Journal of Science and Medicine in Sport by Sarah Reinking et al. examines one less-known concussion symptom: kinesiophobia, or the fear of movement. In this prospective cohort study with 49 adolescent participants (32 concussion patients, 17 control), individuals were given two evaluations which included the following tests: Tampa Scale of Kinesiophobia, Post-Concussion Symptom Inventory, and clinical reaction time assessments.

Sport-related concussion patients were evaluated within 14 days of the initial incident and again at return-to-play. The control group received an initial evaluation and a follow-up approximately 28 days later. The study results showed that of individuals who suffered a sport-related concussion, 28% were still reporting kinesiophobia on the return-to-play day. Additionally, the authors observed a correlation between high Tampa Scale scores and slow reaction time.

It is essential to acknowledge the persistence of kinesiophobia following concussion, especially when it comes to athletes. If an athlete becomes anxious with movement, it could have a severe impact on not only their sport but could carry over into their daily life. Further research on kinesiophobia can be beneficial for any concussion patient, athlete, or not.

Targeted vestibular rehabilitation significantly helps adolescents with symptoms such as dizziness

See our synopsis of this study in our Therapies Currently Available section, above.

Women's Health

Comprehensive overview of why sports concussions are worse for women

Nature published a comprehensive news feature “Why sports concussions are worse for women–As women’s soccer, rugby and other sports gain popularity, scientists are racing to understand how the female brain responds to head injury.” We’ve covered many of the studies that the article references, but this is an excellent overview of this concerning issue. If you prefer, you can listen to the article in an “audio long-read.”