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Generally, after suffering a concussion, patients are encouraged to avoid reading, watching TV and using mobile devices to help their brains heal. But new research shows that teen-agers who used a mobile health app once a day in conjunction with medical care improved concussion symptoms and optimism more than with standard medical treatment alone.
Researchers from The Ohio State University Wexner Medical Center and Cincinnati Children’s Hospital Medical Center collaborated on the study with Jane McGonigal of the Institute for the Future, who developed the mobile health app called SuperBetter after she suffered a concussion.
Results of the study are published online in the journal Brain Injury.
The 19 teens who participated in the study received standard of care for concussion symptoms that persisted beyond 3 weeks after the head injury, and the experimental group also used the SuperBetter app as a gamified symptoms journal.
“We found that mobile apps incorporating social game mechanics and a heroic narrative can complement medical care to improve health among teenagers with unresolved concussion symptoms, said first author Lise Worthen-Chaudhari, a physical rehabilitation specialist who studies movement at Ohio State’s Wexner Medical Center’s Neurological Institute.
The American Academy of Neurology recommends limiting cognitive and physical effort and prohibiting sports involvement until a concussed individual is asymptomatic without using medication. However, this level of physical, cognitive and social inactivity represents a lifestyle change with its own risk factors, including social isolation, depression and increased incidence of suicidal ideology, the researchers noted.
In addition, cognitive rest often involves limiting screen stimulation associated with popular modes of interpersonal interaction, such as text messaging and social networking on digital platforms, including Facebook, Twitter, Instagram and multiplayer video gaming, thereby blocking common avenues for social connection.
“Teens who’ve had a concussion are told not to use media or screens, and we wanted to test if it was possible for them to use screens just a little bit each day, and get the bang for the buck with that,” Worthen-Chaudhari said. “The app rewrites things you might be frustrated about as a personal, heroic narrative. So you might start out feeling ‘I’m frustrated. I can’t get rid of this headache,’ and then the app helps reframe that frustration to ‘I battled the headache bad guy today. And I feel good about that hard work’.”
Concussion symptoms can include a variety of complaints, including headaches, confusion, depression, sleep disturbance, fatigue, irritability, agitation, anxiety, dizziness, difficulty concentrating or thinking clearly, sensitivity to light and noise, and impaired cognitive function.
Within the SuperBetter app, symptoms were represented as bad guys such as headaches, dizziness or feeling confused, and medical recommendations were represented as power ups, including sleep, sunglasses or an academic concussion management plan. Participants invited allies to join their personal network in the app and they could view their in-app activity and could send resilience points, achievements, comments and personalized emails in response to activity.
“Since 2005, the rate of reported concussions in high school athletes has doubled, and youth are especially at risk,” said study collaborator Dr. Kelsey Logan, director of the division of sports medicine at Cincinnati Children’s. “Pairing the social, mobile app SuperBetter with traditional medical care appears to improve outcomes and optimism for youth with unresolved concussion symptoms. More study is needed to investigate ways that leveraging interactive media may complement medical care and promote health outcomes among youth with concussion and the general population.”
An estimated 1.6 to 3.8 million traumatic brain injuries occur every year, according to the Centers for Disease Control and Prevention. More than 75 percent of the injuries are sports-related mild traumatic brain injuries or concussions.
While this issue is being recognized at the professional and elite levels, many youth and collegiate athletic programs across the U.S. lack the adequate medical personnel, specifically concussion specialists, to handle these injuries on the sidelines in real time.
Doctors at Mayo Clinic, in collaboration with the Northern Arizona University football team, conducted a study, Feasibility and Accuracy of Teleconcussion for Acute Evaluation of Suspected Concussion, which was recently published in the journal Neurology. The study, funded by Mayo Clinic, focuses on concussion specialists using telemedicine technology to determine if a player needs to be removed from play in real time.
“Telemedicine has been shown to be a safe and effective means to evaluate and treat numerous acute neurologic conditions, including stroke,” says Amaal Starling, M.D., neurologist and concussion expert at Mayo Clinic. “Now, doctors are starting to explore using telemedicine to manage concussions.”
Dr. Starling and Bert Vargas, M.D., director of the concussion program at UT Southwestern Medical Center, evaluated 11 consecutive male collegiate football players who suffered from a suspected concussion over two football seasons. All athletes received face-to-face baseline examination scores, including a symptom severity checklist, Standardized Assessment of Concussion, King-Devick test, and modified Balance Error Scoring System.
In total, 123 athletes were enrolled in the study, 50 of whom participated through two seasons.
During two football seasons, athletes with suspected concussions were evaluated in person by Northern Arizona University medical personnel and certified athletic trainers. Simultaneously, Dr. Vargas or Dr. Starling would perform a concussion examination via a telemedicine robot.
“During the remote examination, we had the ability to ask additional questions and repeat any portion of the physical evaluation,” says Dr. Vargas. “The decision as to whether or not the athlete should be removed from play was made by both the athletic trainer and neurologist.”
Both physicians had high agreement with the evaluation scoring and 100 percent agreement of the most important decision — removal from play. This suggests neurologists may be able to use telemedicine to manage concussions, make removal from play decisions, and close the gaps in medical care by providing all collegiate and youth athletes similar concussion care as professional athletes receive.
To reduce the risk of concussion, researchers and others have sought ways to improve helmet technology as a way to resolve the problem.
A better solution may be to ditch the helmets altogether, according to a new study in the Journal of Athletic Training, the National Athletic Trainers’ Association’s scientific publication. Researchers investigated the effectiveness of helmetless tackling to reduce head-impact exposure in an NCAA Division I football program.
The study, partially funded by the NATA Research & Education Foundation, showed a 28 percent reduction in head impacts during practices and games. To review “Early Results of a Helmetless-Tacking Intervention to Decrease Head Impacts in Football Players,” please visit:
“Given proper training, education and instruction, college football players can safely perform supervised tackling and blocking drills in practice without helmets,” said Erik E. Swartz, PhD, ATC, FNATA, lead author of the study and professor and chair, Department of Kinesiology, University of New Hampshire. “This intervention also eliminates a false sense of security a player may feel when wearing a helmet. Younger players with less experience may require modifications to this intervention to realize a positive effect. While more research is needed, our results do show a reduction in head impacts during our one season of testing.”
The findings are from the first year of a two-year study in which 50 NCAA Division 1 football players at the University of New Hampshire were assigned to an intervention (25 athletes) or control (25 athletes) group. The intervention group participated in five-minute tackling drills without their helmets and shoulder pads as part of the Helmetless Tackling Training (HuTT) program. Drills occurred twice per week during preseason practices and once per week throughout the competitive season (16 weeks). The control group performed noncontact football skills with no change to their routine. All athletes were provided head-impact patch sensors worn on the skin and new helmets. Both groups were supervised by members of the football coaching staff. At the end of the season, the intervention group experienced an average 30 percent fewer impacts per exposure than the control group.
The notion of removing the football helmet for discrete and regular periods during practice to reduce head impact is counterintuitive to the sport, wrote the authors. “These findings elucidate the risk-compensation phenomenon and may help explain the behavior of spearing and the rise in catastrophic neck and head injuries that followed,” they added. “A football helmet is designed to protect players from traumatic head injury, but it also enables them to initiate and sustain impacts because of the protection it affords. While improving protective equipment in and of itself will not resolve the risk of concussion and spine injury in football, the solution may be found in behavior modification.”
High school and college football players can each sustain more than 1,000 impacts in a season, while individual youth players may sustain 100 during that same timeframe according to the study. “The extent to which this intervention may yield similar outcomes in younger players with less experience is still unknown. We are currently in the first year of a high school study focused on four high schools in New Hampshire,” adds Swartz.
“Should future research replicate our findings, the eventual adoption of helmetless-tackling training may improve public health and decrease the associated economic burden by reducing football-related head and neck injuries and the risk of long-term complications.”