Monthly Archives: November 2011
Boston University (BU) recently announced it will be conducting a new study called DETECT. It is the first study of Chronic Traumatic Encephalopathy (CTE) funded by the National Institutes of Health.
DETECT is a three-year study whose goal is to find differences between NFL players and athletes who haven’t experienced hits to the head. While the only current way to confirm CTE is by examining brains after death, DETECT will analyze the brains of living patients.
Until CTE can be diagnosed during life, it’s impossible to develop treatments or to determine how to prevent it, said Robert Stern, co-director of The Center for the Study of Traumatic Encephalopathy at BU’s School of Medicine.
The researchers hope that genetic testing and other analyses can help them discover why some athletes who receive repeated blows to the head develop CTE and others do not.
They will also recruit 50 retired elite athletes from non-contact sports such as swimming and tennis to serve as a comparison group. They will be recruited through college alumni associations and sports leagues. Dr. Robert Cantu, Chris Nowinski and Dr. Ann McKee are the other co-directors of the center.
The NFL players will consist of only offensive and defensive linemen, linebackers or defensive backs because they encounter the most repeated brain trauma. The NFL subjects will be between the ages of 40 and 60. They must also suffer from some symptoms associated with CTE such as memory loss, impaired judgment, depression or even progressive dementia. Since evidence suggests that CTE can occur through play after play of knocks to the head, multiple concussions are not a requirement of these subjects. The NFL and the players’ union are helping the center contact former players.
“There’s a sense that former players want to be able to do something to not only potentially help themselves but also to help get the research moving quickly to help others in the future,” said Stern.
Subjects are flown to Boston where they undergo a variety of tests. On day one, subjects spend around two hours in scanners for different kinds of neuroimaging. On day two, subjects have a spinal tap, a lengthy psychiatric interview, neurological and cognitive testing and blood work done.
Two more subjects are scheduled for December and the pace will pick up in January. The athletes are promised confidentiality. The center is seeking additional funding to complete the study.
In an attempt to reduce the risk of concussions and traumatic brain injury (TBI) among student athletes, new legislation has been introduced in more than 35 states and enacted in 24 over the past year. The latest new piece of legislation is SB 200, a Pennsylvania law that was publicly signed November 14 at the Lower Dauphin High School in Hummelstown, Pennsylvania by Gov Tom Corbett.
SB 200 is the first law of its kind to include physical therapists as part of the health care team that can determine whether a student athlete should be removed from play after sustaining a head injury and whether or not a student athlete is ready to return to play after suffering a concussion or other TBI.
In accordance with SB 200, student athletes must be immediately removed from participation in any physical activity when a concussion is suspected. SB 200 also requires that student athletes, after sustaining a concussion or TBI, must be evaluated and cleared for participation in writing by an appropriate health care provider trained in the evaluation and management of concussions and other brain injuries. According to the American Physical Therapy Association (APTA), physical therapists are adequately trained to make these decisions.
The APTA supports this new piece of legislation that they believe will help “protect Pennsylvania student athletes,” said APTA Pennsylvania Chapter President Ivan Mulligan, PT, DSC, SCS, ATC.
“We encourage other states to follow Pennsylvania’s example and put similar laws on their books that protect their student and young athletes, while ensuring there is access to a variety of qualified health care providers trained in the examination and management of concussions, including physical therapists,” said Mulligan.
The APTA is currently working to ensure that physical therapists as well as other qualified health care providers are included in similar legislation in other states in order to provide access and collaboration across a wide range of providers in regards to this public safety issue.
More information on concussions and how a physical therapist can help can be found in the Physical Therapist’s Guide to Concussion.
The American Physical Therapy Association (APTA) represents more than 77,000 physical therapists, physical therapist assistants, and students of physical therapy nationwide. Learn more about conditions physical therapists can treat and find a physical therapist in your area at www.moveforwardpt.com. Consumers are encouraged to follow us on Twitter (@moveforwardpt) and Facebook (facebook.com/moveforwardpt).
Even though it’s preliminary research, a recent concussion study may have major implications for the consequences of head hits and could impact football at the fundamental level.
Despite involving a small sample of athletes, this study raises important questions about the effects of mild head injury among youths with developing brains, said lead author Jeffrey Bazarian, M.D. Tong Zhu, Ph.D. and Jianhui Zhong, Ph.D. are co-authors and collaborators of the study.
After being introduced to a “Diffusion Tensor Imaging” (DTI) scan by Dr. Zhong, Dr. Bazarian, an associate professor of emergency medicine at the University of Rochester Medical Center, wondered if DTI scans could aid in the study of concussions. A DTI is similar to an MRI but instead of relaying pictures it relays quantitative data that must be decoded and interpreted by experts.
DTI scans use magnetism to measure the movement of water molecules through the body’s tissues, including the neurons. The DTI scan can provide detailed information about axonal injury. Axons swell when injury occurs and the swelling impacts the movement of water, thus allowing scientists to make an educated guess about the extent of axonal injury by measuring the changes in flow and volume of water.
Dr. Bazarian and Dr. Zhong, a professor of imaging sciences and physics, studied DTI scans of ten local high school football players before and after their seasons. While they originally believed that their research would be meaningless if only one studied player experienced a concussion, they instead found that the result would be very useful.
During the 2006-2007 sports season, nine athletes and six people in a control group from Rochester, N.Y. volunteered to take part in the research. Only one of the nine athletes was actually diagnosed with a sports-related concussion, but six other players sustained various sub-concussive blows and showed abnormalities on their postseason DTI scans that more closely resembled the concussed brain than the normal brains in the control group.
The DTI scans showed a significant change in the white matter of the teenage player with a sports-related concussion. They also showed that among the intermediate group, the white matter changes were three times higher than the controls.
The imaging changes also strongly correlated with the number of head hits (self-reported in a diary), the symptoms experienced, and independent of cognitive test results, Dr. Bazarian said.
Based on their research, they discovered that extreme hits that lead to telltale signs of concussions (foggy vision and starry eyes) weren’t necessary to cause damage to a player’s brain. Rather, regular hits to a players head can accumulate and affect the player’s brain’s wellbeing.
“We didn’t anticipate that blows to the head that didn’t cause a concussion could cause abnormalities on the scan,” Bazarian said.
The results suggested that plays considered ‘the bedrock of game action,’ such as linemen colliding or a running back getting bumped while powering through a hole, could be adversely affecting a player’s health over time.
One advantage of this study is that it compares brain scans from the same player, preseason and postseason, whereas most studies compare the injured brain of one player to the normal brain of another player in a control group. By comparing brain scans from the same player, they are more easily able to notice subtle changes, because so much natural variation exists in each individual’s brain, said Dr. Bazarian.
Dr. Bazarian and Dr. Zhong began to wonder if what they were seeing was the type of injury that, “year-after-year could contribute to the traumatic encephalopathy that affected retired NFL players.”
Traumatic encephalopathy (TE), a degenerative brain condition, has recently been suspected as a long-term affect of concussions. Some experts believe that TE can cause depression and in more serious causes can lead to potentially suicidal behavior.
After receiving a grant from the NFL to continue his research, Dr. Bazarian began to examine the University of Rochester football team. Dr. Bazarian then outfitted ten of Rochester’s football players with special helmets designed by Riddell, which were adorned with sensors to measure each hit a player receives. The sensors, called “accelerometers,” can detect the amount of direct force an impact delivers and also measure how much the impact causes the helmet to rotate.
As part of the study, each player had a DTI scan before the beginning of the 2011 season and will have a second scan when the season ends. By combining the DTI scan with the data from the accelerometers, the researchers can determine if the number of collisions matches the degree of brain injury.
They are also interested in adding a third phase to the study where they will test whether or not the practice of ‘resting players’ if effective. To do this, they must see if the patterns of damage that they discovered will heal after an extended period of inactivity. Thus, players in the study group had to agree to abstain from contact sports for a total of six months after the season ends. After those six months, a third DTI scan will be administered and then compared to the previous scans to check for signs of healing.
Unfortunately, as a result of the three phases, the study will not begin to produce conclusive results until the end of next year. When asked about the study, Dr. Bazarian stated, “At the end of the day, I think we’re just trying to avoid dementia from happening down the line. I have three kids. I don’t want them getting hurt and having brain injury from something they love to do.”