April 11, 2019 Newsletter
Welcome to the Concussion Alliance Weekly Update Newsletter! If you like this newsletter, forward it to a friend and suggest they subscribe.
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Education
An interactive video, CrashCourse, makes use of virtual reality (VR) to teach athletes the latest medical understanding about concussions, including how to recognize a concussion and the health implications of staying in the game after a potential concussion. The video was created by TeachAids.org, a nonprofit that was started at Stanford University.
The first three class modules are now available for the University of Calgary MOOC (massive online open course): Concussion: Prevention, Management, and Treatment. The seven-week course is free, and a certificate is available upon completion; registration is open until May 6th.
Rehab Therapies
Military Medicine has published a study by Anthony P Kontos PhD et al., finding that 51 military and civilian patients who had chronic concussion symptoms (1-3 years) showed "significant improvement in symptoms [including] cognitive, vestibular, oculomotor, and balance function, following targeted intervention interventions.” These interventions involved behavioral, vestibular, vision, and exertional therapy.
A joint statement by the College of Optometrists in Vision Development (COVD) and the Neuro-Optometric Rehabilitation Association (NORA) recommends that concussion patients be given an optometric evaluation and vision rehab if necessary. "Vision-related problems are often overlooked" and can manifest in the form of "headaches, difficulty thinking, memory problems, attention deficits, mood swings and frustration." For more information see our page on Vision Therapy.
Sports
Football Canada, Canada’s governing body for youth football, has announced restrictions on full tackle football for children under 12. A New York Times article earlier this week details the restrictions, which will go into effect in 2022.
The British Journal of Sports Medicine has published a consensus statement from Gavin Davis et al. detailing newly refined definitions of six video signs of possible concussion in professional sports: “lying motionless, motor incoordination, impact seizure, tonic posturing, no protective action—floppy and blank/vacant look.” Thirteen representatives from seven professional sports participated in creating this international consensus, which will be used by professional sporting bodies and as the foundation for further research.
Cannabis
A new study led by NEEKA Health Canada will "test if CBD-based therapies can reduce the severity of post-concussion brain disorders in former NHL players." The National Hockey League Alumni Association and Canopy Growth Corp. (a cannabis and hemp company) are partnering with NEEKA for the clinical research; approximately 100 former players will be enrolled in the randomized, double-blind study.
Sleep
An Abby L Blake et al. study published by Sleep Health looks at concussion history and sleep disturbances in collegiate student-athletes, showing that "concussion history is related to persistent changes in sleep, ongoing symptoms, and Quality of Life dysfunctions and should be considered in concussion management protocols even after return to play and academics has occurred."
Diagnostics
A Canadian and US research study published in Brain (Shaun D Fickling et al.) used new applications of technology to diagnose concussions in hockey athletes rink-side. Researchers used a portable EEG and analyzed the complex data with 'brain vital signs' to detect neurophysiological impairments. "This study represents the brain vital signs component of a larger collaborative effort to develop an objective battery of concussion assessments."
Mental Health
Christine MacDonald Ph.D. recently made the presentation “Brain Injury & Psychological Health Following Combat Deployment: The Invisible Wounds of War.” According to an article in The Spokesman-Review, MacDonald (University of Washington) has "worked since 2008 in a long-term study of brain injuries among military service members" and reports that "when we look at the one-year to five-year follow-ups, we actually see a disproportional number of those concussion patients getting worse.”
In some cases, brain injury can interrupt the ion channels in a small area in the brain creating cortical spreading depression. Typically this is seen with moderate and severe brain injury; in a study in the Journal of Neurotrauma, Bouley, J. et al. observed cortical spreading depression in mild TBI (concussion) as well.
Dr. Uzma Samadani and Rosina Samadani discussed cortical spreading depression in the context of differentiating subtypes of concussion in the future. The interview was on the Faces of TBI podcast with Amy Zellmer discussing their EyeBOX device for concussion diagnosis.
Intimate Partner Violence
A Forbes article reports that traumatic brain Injuries from intimate partner violence (IPV) is "a global health epidemic going completed untreated." The number of TBIs reported from IPV is far greater than from military and NFL concussions. "About 1,600,000 women [annually] are estimated to sustain repetitive IPV-related TBIs in comparison to the total annual numbers of TBIs reported for the military and NFL (18,000 and 281, respectively)." The author, Nicole Fisher, is a Concussion Alliance Advisory Board Member.
Emergency Rooms
A study by Morrison L et al. in the Cambridge Journal of Emergency Medicine found that patients who "were referred to a specialized clinic were less likely to return" to the ER. This finding "suggests the opportunity to reduce this burden to both the healthcare system and the patient through careful discharge instructions outlining anticipated symptoms following a concussion (specifically, headache) or referral to a concussion clinic."
Another study of concussion patients in the ER by Seth A. Seabury et al. published in JAMA Network Open found that "a large proportion of patients with mTBI do not receive follow-up care after injury." Less than half of the ER concussion patients reported receiving concussion educational material at discharge, and less than half reported seeing a medical practitioner within three months of the injury. The results highlight the need for better follow-up "including systems of care specifically designed to offer follow-up treatment to patients with mTBI."
