I was watching the film “Ali” one night, and became inspired to do a bit of research on sports injuries and dementias. You can read my first post on “Ali” and boxer’s dementia here.

Do Sports Concussions Increase the Risk of Alzheimer’s

US Against Alzheimer’s September, 2013 podcast

A discussion with Dr. Mark Burns, Assistant Professor of Neuroscience and Director of the Laboratory for Brain Injury and Dementia at Georgetown University, about his research on the link between traumatic brain injury (TBI) and Alzheimer’s disease. This call was made possible by the generous support of Shawn Taylor, board member of USAgainstAlzheimer’s Network.

“So what does all this mean for us? Right now what we have learned is that we’re beginning to understand why a moderate to severe traumatic brain injury might be increasing your risk of developing Alzheimer’s disease.

Professional athletes who suffer from repeat concussions and this dementia that they are getting looks very similar to Alzheimer’s disease. So the first big study that looked at NFL players only got published in 2005 and they followed up more than two and half thousand retired NFL players, and these are people who had an average professional career of about 5 and a half years in the NFL. What they ask these players to do is report how many concussions they had over their career and 60% of them said they had one concussion and 24% of them said they had three or more concussions. And what they also found was that the players that had three or more concussions were 5 times more likely to be diagnosed with mild cognitive impairment, so that’s the precursor to Alzheimer’s disease. And they were more likely to develop Alzheimer’s disease at an earlier age than the general population. So while the rates of Alzheimer’s seemed to be similar, it seemed to start earlier in retired NFL players.

So the disease that these football players are getting is actually not Alzheimer’s disease it’s called Chronic Traumatic Encephalopathy or CTE. And so CTE is form of brain damage that we’ve known about for quite a long time. The symptoms of it were first recorded in boxers back in 1928. So we’ve known about this disease for almost 90 years and it’s one of the reasons why doctors for many, many years called for the banning of boxing because it just seemed like such an easy way to prevent this disease. But now it seems that it’s occurring in multiple types of sports including football, ice hockey, rugby, soccer, or any sport associated with an impact to the head.”

You can listen to the 1 hour discussion on the topic at the USAgainstAlzheimer’s Network page by following this link. You can also view a PDF of the transcripts if you wish.

Dementia Four Times More Likely in Pro Football Players

Taken from Alz Forum 07 Sep 2012

Players who spent at least five seasons battling it out in the National Football League (NFL) are three times more likely to die of a neurodegenerative disease than is the general population. Their risk for dying with dementia or amyotrophic lateral sclerosis hits fourfold. These sobering statistics appeared in the September 5 Neurology online. “Those are very high numbers,” said lead author Everett Lehman, National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio. “We conduct a lot of mortality studies, and we do not see such high risks very often,” he told Alzforum. (Uranium miners are one group that comes close.)

“The data support a notion that many of us have had: that playing a contact sport for a good chunk of your life at a high level is a risk for a variety of neurodegenerative disorders,” said Jeffrey Kutcher, University of Michigan, Ann Arbor. Kutcher did not participate in this study.

Growing evidence links sports-related head injuries, mostly concussions, to neurological problems and neurodegeneration later on in life (see ARF related news story). The medical field now recognizes chronic traumatic encephalopathy (CTE) as a major problem among football players, boxers, and other participants in contact sports. Against that backdrop, these new figures do not necessarily come as a huge surprise, said Lehman. Robert Cantu, Co-Director of the Center for the Study of Traumatic Encephalopathy at Boston University, agreed. “The BU center stores more than 100 donated brains, of which 30 are from deceased NFL players, and all had CTE,” Cantu told Alzforum. He was quick to point out that his may not be a representative sample, as the donations came predominantly from players who took their own lives or had severe problems later in life. “But we know CTE is out there, we just don’t know the prevalence and incidence,” he said.

Lehman and colleagues tried to address that issue in what Cantu considered pioneering work. The NIOSH researchers focused on more than 3,400 football professionals who played in the NFL between 1959 and 1988. Lehman followed them through 2007, documenting mortality. By then, 334 of them had died at an average age of 54. The good news is that, overall, the NFL retirees were half as likely to die during this period as were members of the general population. “As you can imagine, these are very fit individuals who received excellent medical attention,” said Lehman. Alas, how they died told another story. On standard death certificates, neurodegenerative disease, including Parkinson’s, Alzheimer’s, and amyotrophic lateral sclerosis (ALS), turned up three times as often as underlying and contributing causes of death as it did for non-players. Narrowing that down, deaths related to dementia/AD and ALS were 3.86- and 4.31-fold higher, respectively. Both these diseases share pathologies found in CTE, including deposits of hyperphosphorylated tau and the RNA-binding protein TDP-43 (see ARF related news story). “Most of the existing data aimed at estimating the prevalence of major neurodegenerative diseases (AD, CTE, ALS) are postmortem and unavoidably biased. This study is unusual and important in the inclusion of ‘all-cause’ mortality data,” noted Sam Gandy, Mount Sinai Medical Center, New York, in an e-mail to Alzforum.

Other researchers contacted by Alzforum said that while these numbers are high, they are probably underestimates. Doctors often don’t record dementia as a contributing cause of death, especially in 50-year-olds, agreed Lehman (ARF related news story). Cantu noted that people with CTE can be asymptomatic for as long as 20 years, and without biopsy data a diagnosis of neurodegeneration may be missed. CTE was not even a recognized condition when many of these players passed away.

Underestimates or not, there are limitations to the study, as Lehman pointed out. Data on injuries and concussions were unavailable, and cause and effect cannot be established in this retrospective analysis. “We can presume impact led to these [mortality] rates being higher, but there are other variables to consider as well, including genetics and lifestyles that might put NFL players at risk, said Kutcher. A hint of the importance of impact comes from breaking down the data by player position. Defensive and offensive linemen fared best, being 1.6 times as likely as a non-NFL player to die of a neurodegenerative disease. That number jumped to 4.74 for players who tackle or are tackled at speed (including linebackers, running backs, quarterbacks, tight ends, and most other positions). The likelihood a physician noted dementia/AD or ALS on a “speed” position player’s death certificate was sixfold higher than normal.

“An important follow-up to this study would be to hunt for identifiable familial/genetic risk alleles that might enable the prospective prediction of those at highest risk,” wrote Gandy. He noted that the increase in risk in the NFL players is roughly equivalent to that associated with a single ApoE4 allele, but that the combination of an ApoE4 allele and a serious traumatic brain injury with loss of consciousness could increase the risk for AD by 10-fold.

What do these data mean for the NFL? League spokesperson Greg Aiello sent Alzforum a prepared statement (see below) that outlined recent steps the league has taken to reduce player injuries. They include new rules that penalize for helmet-to-helmet contact. The league has also invested in research and care. Though the NFL dragged its heels in recognizing the seriousness of head trauma in years past (see ARF related news story), researchers now see signs that it is moving in the right direction. “I think since 2010, no other organization, professional or amateur, has done even a fraction of the amount of good toward protecting its participants with regard to head trauma as the NFL,” said Cantu. Kutcher agreed that the changes implemented by the NFL will help. “The big question is whether we can quantify that,” he said. “Where it will end up, we don’t know,” said Cantu, “but I don’t believe they can ever make [football] completely safe.”—Tom Fagan.

Reference:
Lehman EJ, Hein MJ, Baron SL, Gersic CM. Neurodegenerative causes of death among retired National Football League players. Neurology. 2012. September 5. Abstract

Today’s coaches and trainers are promoting safety, strength, and conditioning to protect players from disabling injuries

From Health Day, last updated March, 2015

By Tim Fitzgerald

Aaron Rogers led the Green Bay Packers to the Super Bowl title in 2011, but the road to the championship wasn’t easy. The quarterback suffered two concussions during the season, a one-two punched that temporarily clouded his thinking and threatened his season.

Rogers had plenty of company: 2010 was the year of the concussion in the NFL. The league reported 154 concussions in the just first half of the season and preseason, up 21 percent from the previous years. Sure, guys were hitting hard, but the league says that much of the spike can be chalked up to greater awareness of concussions. On fields, rinks, and courts across the country, there’s a new push to protect the people who put their health on the line in the name of sports.

Professional athletes risk injury every time they train, practice, and compete. It’s not surprising, then, that professional athletes were among five occupations that had more than 1,000 injuries per 10,000 workers. Athletes and sports competitors suffer more than 2,000 injuries per 10,000 workers, according to the Bureau of Labor Statistics. (Only an athlete, for example, is likely to experience turf toe, pitcher’s elbow, or a sports hernia.) Getting hurt is a part of sports, but today injuries play a larger role — and receive more attention from teams and the media alike — than at any time in sports history.

The 2000s saw injuries increase in three major U.S. sports: the National Football League (NFL), major league baseball, and the National Hockey League. With this has come a more vigilant, proactive approach to preventing players from getting hurt, as well as a larger emphasis on keeping athletes healthy once their playing days are over.

Football: collisions, tackling, and turf monsters

A sport in which most plays end with someone being tackled is bound to have its share of injuries. Football’s hazards are receiving a lot of attention these days — concussions, in particular. Recent studies have found that the damage can reverberate far beyond the football field. In 2009, researchers at the University of Michigan announced a shocking study of the long-term effects of repeated blows to the head. The study found that ex-NFL players over 50 were diagnosed with dementia at a rate five times the national average.

The attention to concussions has led manufacturers to modify the helmet itself to absorb the impacts players take to the head. The National Operating Committee on Standards in Athletic Equipment (NOCSAE) continuously investigates ways for helmet manufacturers to improve helmets, such as thicker outer shells, softer inner padding, and air-filled compartments, which shape and move with a player’s head to distribute the force of an impact.

Officials are also strictly enforcing rule changes prohibiting helmet-to-helmet contact and striking an opponent above the shoulders. Stiff penalties, fines, and suspensions accompany violations of these rules. Still, concussions remain a problem, possibly because today’s athletes are bigger, faster, and stronger than in previous years. Linebackers these days run as fast as running backs and receivers, and weigh roughly 230 to 250 pounds, creating more vicious collisions and thus more injuries.

The “turf monster,” which has been known to reach up with its fuzzy, green, stiff-carpet grip to end a player’s game or season, is another nemesis of football players. Artificial surfaces are famous for causing injuries when a player hasn’t even been tackled. Among the victims is Jamal Anderson, the star halfback of the Atlanta Falcons, who was planting his foot to make a cut on artificial turf when he blew out the anterior cruciate ligament in his right knee.

League dynamics, such as expansion and a salary cap, have put the spotlight on such injuries. Expansion has watered down talent across the league, and the salary cap has limited the number of “big money” players on a given squad. These factors are responsible for teams carrying fewer veteran or talented backup players, which has made rosters more vulnerable in the event of injury. If a key player goes down, the teams go down as well.

To help prevent injuries, Oakland Raiders head trainer Rod Martin recommends training and conditioning specific to the sport. “For football, we train for the angles and direction changes that come with the sport,” Martin says. “Often, players will just train by running sprints and long distances in a straight line, but that’s not the way the sport is played.”

The most common injuries Martin sees are hamstring and groin pulls and strains. He recommends athletes train on the surface they play on and that they wear proper shoes when they practice. “We primarily play on grass, and therefore we have the players practice on it in their cleats to avoid leg muscle pulls and strains,” he explains. According to Martin, keeping properly hydrated by drinking plenty of water during training and before games is one of the most important things a player can do. “This will reduce more than cramps,” he says. “It will reduce muscle fatigue which decreases the chance for injury.”

Baseball: In search of a safer athlete

As in football, injuries in baseball have sidelined dozens of major players According to former San Francisco Giants head trainer Stan Conte, now with the Los Angeles Dodgers, major league baseball’s injuries increased 3 percent every year between 1989 and 1999 — a rise that some experts attribute to steroids. “The side effects from the steroids was the increased injuries, because players were more fragile and their muscles were becoming too big, and the training was too intense for the body,” Barry Axelrod, treasurer of the U.S. Anti-Doping Agency, told the New York Times.

The numbers plummeted in 2002, a year before baseball began testing for steroids and remained lower until the numbers jumped 26 percent from 2006 to 2008. Some insiders have said that testing for stimulants may be one reason — stimulant use had postponed symptoms of injuries, and without them, athletes realized they could not continue to play through the pain. The numbers of injuries leveled off somewhat in 2010, although the roster of injured players in recovery, including Johan Santana and Carlos Beltran, is still substantial.

Conte points out that some injuries are unavoidable, but if a team manages to reduce them, he says, “It’s not luck, it’s preparation.”

The Giants, for example, changed their conditioning program to feature functional exercises specifically designed to prevent baseball injuries: “Before, pitchers were conditioned with slow cardiovascular training, because pitching was always compared to a marathon. But it’s not,” Conte explained.

He explained that pitching is a series of short, explosive movements done repetitively. For this reason, he changed the pitchers’ training and conditioning to rapid-movement drills to reduce throwing injuries, which make up 48 to 50 percent of the injuries he treats. The change was also intended to reduce the leg injuries that can occur when pitchers kick out one of their legs during delivery, and the sudden shift from pitching delivery to fielding.

This kind of conditioning can also help pitchers dodge screaming line drives up the middle, which can be extremely dangerous. In a frequently replayed, gruesome incident, Boston Red Sox pitcher Bryce Florie was hit in the face by a batted ball, suffering a broken eye socket, a nasal fracture, and retinal damage. Sometimes a foul can be just as dangerous: in March 2011, Atlanta Braves minor league manager Luis Salazar lost his left eye after he was hit in the face by a wayward line drive.

Hoop Dreams

Basketball fans playing pretend managers blog about the many injury-prone NBA players they might (reluctantly) not draft. Truth is, injuries are all too common in basketball, even among weekend warriors on the playground, and are especially hard to prevent in the NBA, with teams playing an 82-game season, plus practice and off-season play. The American Orthopaedic Society for Sports Medicine (AOSSM) recommends preventing jumpers’ knee through strengthening and increasing flexibility of the quadriceps muscles, and by resting when the pain becomes too intense. But if tendonitis still occurs, the AOSSM recommends rest, strengthening, and neoprene sleeves and braces to keep the injured area warm. The society also recommends heating the area before activity and icing it for 20 to 30 minutes afterwards.

Playing through pain

Contrary to Hollywood myth, trainers do not drug or “shoot up” a player to get them out and win the big game, Martin says. “I’ve never known that to exist in my years as a trainer,” Martin says. “That would ruin the good-faith relationship between player and trainer, and they would no longer have confidence in their medical staff.”

Martin prefers a player come to him as soon as he feels something is wrong. He knows, however, veteran players can often figure out whether they need assistance or whether an injury is minor enough that they can take care of it themselves, and prevent it from becoming serious. Athletes, especially veterans, are in tune with their bodies, and they tend to know the difference between being just sore or worn down and when they are injured. It’s not wise to let an injury linger, so an athlete should seek medical attention from his or her trainer or a sports physician to immediately prevent it from worsening.

“There’s nothing like experience,” Martin says. “If an athlete has had an injury before, they know what to expect. They can feel when they need medical attention and are less uncertain about what will happen next.”

But there are times when a player’s competitive fire gets the best of him, and that’s when Conte says he takes matters into his own hands. “Much like a football trainer takes a player’s helmet to keep him from sneaking back into the game, I’ll take a guy’s glove,” he says. “When a player is on the field injured, neither he, nor his team benefits.”

Mind over matter

How a pro athlete mentally approaches the constant specter of injuries — some potentially career-ending — is very important to avoiding them. “If a player is worried about getting injured and trying to not get hurt is their main goal,” says veteran trainer Mike Abdenour of the Detroit Pistons, “then they play timid and are too conscious of getting hurt, and that’s when there is an increased chance for injury.”

But experienced athletes also realize that serious injuries can sideline them. “That is their motivation for strength and conditioning,” Martin says. “Athletes are extremely motivated people, and they know they must train properly to lower their chance for injury.”

Recovering from an injury requires the proper mentality as well. If an athlete remains in low spirits and feels there is no hope to return after an injury, he may not rehab properly. “After the initial disappointment and depression an athlete goes through during a serious, rehab-requiring injury, they usually accept it,” says Conte. “From there they focus on rehabilitating and getting back to the form they were in. This is the pattern for those who dedicate themselves and rehabilitate well.”

Turf injuries, concussions, broken bones: some injuries may be unpreventable. But coaches and trainers agree that proper training and precautions can help prevent a promising athletic career from being cut short. Thanks to a proactive and preventive training approach, other players like Ram wide receiver Isaac Bruce will be able to celebrate championships, not on crutches and in street clothes, standing on the sidelines, but on the field, in uniform, competing and doing their jobs.

References

Owens, Shannon J. “Luis Salazar loses left eye after Atlanta Braves training mishap. Orlando Sentinel, March 16, 2011.

National Football League. Concussions reported in NFL up 21 percent from last season. 2010. http://www.nfl.com/news/story/09000d5d81cdf2d6/article/concussions-reported-in-nfl-up-21-percent-from-last-season

University of Michigan. Study of retired NFL players. 2009. http://ns.umich.edu/Releases/2009/Sep09/FinalReport.pdf

Schmidt, Michael. Increasing pace of injury hampers baseball. New York Times, July 6, 2009.

Most Injury-Prone Players in the NBA, Opposing Views, Sept. 10, 2010.

Interview with Oakland Raiders trainer Rod Martin

Interview with Stan Conte

Occupational Injuries, Bureau of Labor Statistics

National Institutes of Health and National Football League Tackle Concussion Research

From the Foundation for the National Institutes of Health

NIH announces research projects funded largely by donation from the NFL

On December 13, 2013, the NIH announced research projects funded through the Sports and Health Research Partnership

CONTACT: NINDS Press Team [email protected] (301) 496-5751

The National Institutes of Health has selected eight projects to receive support to answer some of the most fundamental problems on traumatic brain injury, including understanding long-term effects of repeated head injuries and improving diagnosis of concussions.

Funding is provided by the Sports and Health Research Program, a partnership among the NIH, the National Football League, and the Foundation for the National Institutes of Health (FNIH). In 2012, the NFL donated $30 million to FNIH for research studies on injuries affecting athletes, with brain trauma being the primary area of focus.

Traumatic brain injury (TBI) is a major public health problem that affects all age groups and is the leading cause of death in young adults. Recently, concern has been raised about the potential long-term effects of repeated concussion, particularly in those most at risk: young athletes and those engaged in professions associated with frequent head injury, including men and women in the military. Current tests cannot reliably identify concussions, and there is no way to predict who will recover quickly, who will suffer long-term symptoms, and which few individuals will develop progressive brain degeneration, called chronic traumatic encephalopathy (CTE).

“We need to be able to predict which patterns of injury are rapidly reversible and which are not. This program will help researchers get closer to answering some of the important questions about concussion for our youth who play sports and their parents,” said Story Landis, Ph.D., director of the National Institute of Neurological Disorders and Stroke (NINDS), part of NIH.

Two ($6 million each) are large, cooperative agreements focused on defining the scope of long-term changes that occur in the brain years after a head injury or after multiple concussions. The cooperative awards form a partnership between NINDS, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and multiple academic medical centers.

NIH also will fund six pilot projects totaling just over $2 million that will last up to two years and are designed to provide support for the early stages of sports-related concussion projects. If the early results are encouraging, they may become the basis of more comprehensive projects. The NIH institutes responsible for managing these grants are NINDS, NICHD, and the National Institute on Deafness and Other Communication Disorders (NIDCD).

The eight projects were selected by the NIH following a rigorous scientific review process.

The cooperative awards bring together two teams of independent scientists to study and compare the brains of donors who were at high or low risk for developing long-term effects of TBI. Ten neuropathologists from eight universities will coordinate to describe the chronic effects of head injury in tissue from hundreds of individuals in order to develop standards for diagnosis.

The project includes four teams that will correlate brain scans with changes in brain tissue, using a variety of techniques. This may open the possibility of using these advanced brain imaging techniques to diagnose chronic effects of TBI in living individuals. The investigators in the two projects will also help NIH develop a registry dedicated to enrolling individuals with a history of TBI who are interested in donating brain and spinal cord tissue for study after their death. The new NIH Neurobiobank (https://neurobiobank.nih.gov) will coordinate the tissue collection, data gathering, and also distribute biospecimens, along with relevant information to enable other scientists to access this valuable tissue.

The two cooperative agreements are:

1.  CTE and Post-traumatic Neurodegeneration: Neuropathology and Ex Vivo Imaging. Principal Investigator: Ann C. McKee, M.D., Boston University School of Medicine and U.S. Department of Veterans Affairs

At present, the diagnosis of CTE is made by examining the brain after death; however, the range of specific features that identify this disorder has not been established. One goal of Dr. McKee’s project is to define a clear set of criteria for the various stages of CTE and to distinguish it from Alzheimer’s, amyotrophic lateral sclerosis, and other neurodegenerative disorders in post-mortem brain tissue. Once these characteristics have been defined in brain tissue, the imaging teams at Washington University in St. Louis and Massachusetts General Hospital  in Boston will correlate them with brain scans to identify features that might eventually be used to diagnose CTE in individuals during their lifetimes.

2.  Neuropathology of CTE and Delayed Effects of TBI: Toward In Vivo Diagnostics. Principal Investigator: Wayne Gordon, Ph.D., Mount Sinai Hospital, New York City

The goal of Dr. Gordon’s project is to identify and describe the chronic effects of mild, moderate and severe TBIs and compare these with the features of CTE. Dr. Gordon and his colleagues at the University of Washington in Seattle will comprehensively evaluate brain tissue obtained from an ongoing study of thousands of people, the Adult Changes in Thought (ACT) study, funded by the National Institute of Aging. They also will examine brain tissue from donors who suffered severe TBI and were cared for in the TBI Model Systems program funded by the Department of Education’s National Institute on Disability and Rehabilitation Research. In Dr. Gordon’s project, neuroimaging teams at Massachusetts General Hospital, Oregon Health Sciences University in Portland, and the University of Washington will use a variety of sophisticated brain scanning techniques in patients with a range of head injuries, as well as on post-mortem tissue, to identify potential markers that may eventually be used to diagnose the degenerative effects of TBI in people.

“The investigators will collaborate to develop diagnostic criteria for identifying the chronic features of the entire scope of brain trauma ranging from mild TBI to full-blown CTE, and then work to extend these criteria to living humans using some of the most advanced neuroimaging tools available,” said Walter Koroshetz, M.D., deputy director of NINDS.

“Although the two cooperative agreements focus on different aspects of TBI, their combined results promise to answer critical questions about the chronic effects of single versus repetitive injuries on the brain, how repetitive TBI might lead to CTE, how commonly these changes occur in an adult population, and how CTE relates to neurodegenerative disorders like Alzheimer’s disease,” Dr. Landis said.

The pilot studies will focus on improving the diagnosis of concussion and identifying potential biomarkers that can be used to track a person’s recovery. The six pilot grants are:

1.  Cortical GABA in Pediatric Sports Concussion. Principal Investigator: Jeffrey G. Ojemann, M.D., Seattle Children’s Hospital

The brain contains numerous chemicals such as gamma-amino butyric acid (GABA), which is important for many brain functions, including cognition and movement, and may be altered by traumatic brain injury. Magnetic resonance (MR) spectroscopy is a scanning technique that can measure a variety of brain chemicals, including GABA. The goal of Dr. Ojemann’s project is to use MR spectroscopy to monitor GABA levels in adolescents who have sports-related concussions and compare those levels to uninjured controls. The researchers also will conduct preliminary comparisons of GABA levels with existing cognitive measures such as memory tests and structural brain imaging. Diagnostic tools that can reliably detect when the brain is injured and when it has recovered following a concussion are essential for determining when it is safe to resume normal activities.

2.  Evaluation of Spot Light: A Concussion Injury Management App for Youth Sports. Principal Investigators: Lara McKenzie, Ph.D., Center for Injury Research and Policy, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio and Dawn Comstock, Ph.D., Colorado School of Public Health, University of Colorado, Denver

Guidelines exist to help doctors diagnose and manage sports-related concussions, but guidelines are not fully supported by evidence-based research, are applied inconsistently, and those responsible for the care of injured athletes do not always fully communicate with each other. The goal of Drs. McKenzie and Comstock’s project is to test the effectiveness of Spot Light, an easy-to-use mobile application (or app), developed by Inlightened, LLC. This app was designed to help doctors, coaches, athletic trainers and parents of young football players track the progress of a young athlete from the time of a concussion injury until they are cleared to return to play. The researchers want to know if the app will result in more concussions being reported, a greater number of referrals to doctors and better adherence to return-to-play guidelines. The goal is to improve diagnosis of concussions that are occurring among young athletes, and ensure that they are receiving appropriate care and are fully recovered before getting back on the field.

3.  Eye Movement Dynamics: A Rapid Objective Involuntary Measure of Concussion/Mild Traumatic Brain Injury. Principal Investigators: Nicholas Port, Ph.D. and Steven Hitzeman, O.D., Indiana University School of Optometry, Bloomington

People can choose where to look, but they do not have much control over some of the intricate eye muscle movements that are usually made without thinking. Studies have shown that eye movement problems are common in mild traumatic brain injury patients. Drs. Port and Hitzeman, in collaboration with team trainers and physicians at Indiana University and local high schools, plan to take advantage of the involuntary, reflex nature of eye movements. They will develop a portable eye tracking instrument that can be used to help diagnose concussions on the sidelines and to monitor injury progression in high school and college athletes. Drs. Port and Hitzeman will compare the eye tracking data to results from a commonly used cognitive test to determine if changes in eye movement can serve as a biomarker for sports-related mild traumatic brain injury. If successful, this study will help provide an objective and more reliable measure to detect traumatic brain injury than is currently available.

4.  Imaging and Biomarkers in Adolescents Cleared for Return to Play After Concussion. Principal Investigator: Harvey Levin, Ph.D., Baylor College of Medicine, Houston

Sports concussions may cause persistent long-term effects in young athletes — in some cases, even after they have been allowed to return to play. Using a variety of neuroimaging techniques, Dr. Levin and his group will look at the effects of sports-related concussions on brain structure and function one month following injury in adolescents who have been cleared to play. In addition, this project will evaluate microRNAs (miRNAs) as potential biomarkers for concussions and recovery. These are small portions of RNA (a molecule that is similar to DNA, which contains our genetic code) that play a role in turning genes on or off. The researchers plan to measure levels of specific miRNAs and determine if they correspond with cognitive test results and neuroimaging data.

5.  Somatosensory Processing — Assessing Youth Sport-Related Concussion and Recovery. Principal Investigator: Stacy Jennifer Marcus Suskauer, M.D., Kennedy Krieger Institute, Baltimore

The somatosensory system provides information about our environment — for example, what an object feels like to the touch — and may be affected by brain injury. Dr. Suskauer and her colleagues will investigate whether somatosensory system information processing (SSIP) could be used as a biomarker for concussion and recovery in youth aged 13-17. For these experiments, the researchers will use a new portable device that delivers vibrations to fingertips. Perception of the vibrations reflects activity of sensory neurons in the brain, thereby providing a measure of SSIP. The researchers will also investigate whether changes in SSIP are related to differences in certain brain chemicals after head injury.

6.  Characterization of the Brain and Serum Metabolome in Mouse Models of Concussion. Principal Investigator: Michael J. Whalen, M.D., Massachusetts General Hospital, Boston

Metabolites are small molecules formed in the body as a result of the normal breakdown of proteins, drugs and other large molecules. The collection of all metabolites in the body is the metabolome. Studies have suggested that head injury may change levels of various brain byproducts, but this has not been researched in a systematic way. Dr. Whalen and his group plan to use an experimental model of traumatic brain injury to conduct a detailed analysis of changes in the brain metabolome following concussion. The researchers will compare those differences with serum byproducts to determine if the changes can be revealed in blood samples. The results of this project may uncover metabolites that contribute to serious effects of traumatic brain injury and may help identify potential targets for detecting and treating concussions.

The NINDS (http://www.ninds.nih.gov) is the nation’s leading funder of research on the brain and nervous system. The NINDS mission is to reduce the burden of neurological disease – a burden borne by every age group, by every segment of society, by people all over the world.

The NICHD (http:www.nichd.nih.gov) sponsors research on development, before and after birth; maternal, child, and family health; reproductive biology and population issues; and medical rehabilitation.

The NIDCD (http://www.nidcd.nih.gov) supports and conducts research and research training on the normal and disordered processes of hearing, balance, taste, smell, voice, speech, and language and provides health information, based upon scientific discovery, to the public.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.

About the Foundation for the NIH (FNIH): Established by the United States Congress to support the mission of the NIH—improving health through scientific discovery in the search for cures—the Foundation for the NIH is a leader in identifying and addressing complex scientific and health issues. The foundation is a not-for-profit, 501(c)(3) charitable organization that raises private-sector funds for a broad portfolio of unique programs that complement and enhance NIH priorities and activities. For additional information about the Foundation for the NIH, please visit www.fnih.org.