Tackling Concussion Research

by Hallee Foster '15

Former-49ers Quarterback, Alex Smith, bears a brutal sack to the head. [image via]

Three-letter acronyms abound in our society – NRA, NBA, CDC – and often name agencies that seldom interact. However, an unlikely friendship has recently formed between two three-letter permutations that seem to occupy opposite sides of the spectrum: NFL and NIH. In 2012, the NFL – yes, the National Football League – donated a whopping $30 million to the Foundation for the National Institutes of Health to fund research on traumatic brain injury – a subject that hits close to home for the NFL and its players.

Traumatic brain injury (TBI) is a serious public health problem with an ever-widening scope of severity. It is currently the number one cause of death amongst young adults [1] and is a particular menace to young athletes. Perhaps even more frightening than its prevalence is its nebulosity. We have no rapid, reliable diagnostic methods for concussions and know little about the long-term consequences of repetitive insult to the head other than the high risk of developing progressive brain degeneration, chronic traumatic encephalography (CTE). Brains afflicted by CTE show demonstrable physical damage, including excess protein build up and tangled cells. CTE produces symptoms analogous to those of Alzheimer’s – irritability, confusion, depression, mood swings, memory loss, and cognitive difficulties. Preliminary tests have revealed that several former high-profile athletes, including Hall of Fame running back, Tony Dorsett, may be living with CTE. Fifty-four former-NFL players have donated their brains for scientific analysis post-mortem to the Center for the Study of Traumatic Encephalopathy at Boston University. Fifty-two of said brains show marked signs of brain damage from repeated concussions [2].

Tony Dorsett, who rushed for more than 12,000 yards with the Dallas Cowboys, has been diagnosed with signs of CTE. [image via]

The rapid pace of contact sports demands that deciding whether to pull the star quarterback out of the game after a brutal sack be made as quickly as deciding which offensive play to run.  There is no grace period for extensive medical evaluations, MRI scans, or a cup of coffee with your neurologist. Modern sideline sports medicine lacks a surefire way to identify a concussion the moment it happens. After decades of flirting with and often turning a blind eye to concussions' deleterious and long-term effects, the NFL is finally confronting brain injury - a concern that should reign superior to all other aspects of the game. The NFL desperately needs a concussion test that can gauge severity and inform thoughtful decisions without delaying the game.

With this in mind, the NIH announced last December that it plans to fund 8 sports-related concussion projects, at a pretty price tag of just over $14 million Here’s the sound bite on each of these innovative endeavors:

• At Boston University’s School of Medicine, Ann C. McKee, M.D. and her team are working to redefine the diagnosis criteria of CTE. Right now, CTE can only be diagnosed post-mortem. McKee and her colleagues hope to pinpoint markers of CTE that are identifiable on the brain scan of a living person, thus offering the hope of halting brain deterioration during a patient’s lifetime.
• At Mount Sinai Hospital in New York City, Wayne Gordon, Ph.D. and colleagues at the Brain Injury Research Center are comparing brain images of mild-to-severe brain injury to cases of CTE in hopes of elucidating a correlation between injury severity and potential CTE progression.  
• At Seattle Children’s Hospital, Jeffrey G. Ojemann, M.D. is expanding upon previous evidence that TBI alters levels of GABA, an inhibitory neurotransmitter. He and his team hope to develop measures, such as memory tests and structural imaging, which will exploit GABA levels as an indication of concussion severity and recovery progress.
• A group at The Research Institute at Nationwide Hospital in Columbus and the Colorado School of Public Health are developing a new smart phone app, Spot Light, to help coaches, parents, and doctors effectively communicate and track an athlete’s recovery post-concussion. The app aims to improve concussion reporting, doctors’ referrals, and adherence to treatment guidelines. 
• At the Indiana University School of Optometry, Nicholas Port, Ph.D. and Steven Hitzeman, O.D. are expanding upon established evidence that those with TBI often exhibit impaired eye movements. They are developing a portable eye-tracking system for use on the sidelines to help diagnose concussions mid-game. 
•  Harvey Levin, Ph.D. and his colleagues at the Baylor College of Medicine will be investigating the effects of concussions on the brain structure and function of adolescent athletes. They will also explore whether small portions of RNA can serve as reliable clinical measures of concussion severity. 
• At the Kennedy Krieger Institute in Baltimore, Stacy Suskauer, M.D. and her colleagues are taking advantage of the fact that TBI may alter somatosensation – our ability to detect touch. They are introducing a portable device that delivers vibrations to the fingertips, thereby stimulating particular cells in the brain, to gauge whether somatosensory function is intact.  They hope to use this device to test for concussions.
• At Massachusetts General Hospital, Michael Whalen, M.D. is studying whether TBI changes the levels of various molecular byproducts in the brain. This research may identify molecules that can serve as markers of concussions as well as targets for treatment and recovery. 

You know something's wrong when your brain turns yellow. [image via]

In addition to the NIH collaboration, the NFL has also recently struck a deal with General Electric to begin a 4-year, $50 million initiative to develop brain imaging machinery that can better predict and analyze sports concussions [3]. These research efforts mark the beginning of a promising, much-needed intersection between basic science and American sports culture. Demystifying the symptoms and understanding the consequences of sports-related concussions offers the hope of dissolving the wall of ignorance between our nation’s athletic machismo and the impact that it has on our athletes’ bodies. Incorporating modern neuroscience into the decisions of players, parents, and coaches in every athletic realm ranging from 5 year-old municipal t-ball to Super Bowl XLIX has the potential to make sports smarter, safer, and ultimately more sustainable. One of the leading concussion research advocates and co-founder of the Sports Legacy Institute – a nonprofit organization dedicated to facing the “concussion crisis”— Chris Nowinski, puts it succinctly: “Football is a constantly evolving game, we’re asking it to evolve again.”

1. "NIH and NFL Tackle Concussion Research." U.S National Library of Medicine. U.S. National Library of Medicine, 16 Dec. 2013. Web. 28 Feb. 2014.
   
2. Castillo, Michelle. "Concussion Research Advocate: NFL Needs to "evolve" to Protect Players." CBSNews. CBS Interactive, 31 Jan. 2014. Web. 16 Mar. 2014.
   
3. Copeland, Kareem. "Report: NFL Partners with GE for Concussion Research." NFL.com. N.p., 3 Feb. 2013. Web. 16 Mar. 2014.