Concussion (mild traumatic brain injury) has received increased recognition and concern among clinicians, researchers, military personnel, sporting organizations, athletes and parents, and the general population. It is now a major public health concern facing the medical community and society at large in the United States and worldwide. In many ways, concussion research is in its infancy relative to moderate and severe brain injury with substantial gaps in our fundamental understanding of injury prevention, pathophysiology, diagnostics, management, outcomes, and financial impact.
The overall mission of Michigan NeuroSport is fueled by our research which focuses on discovering optimal care for acute concussion as well as understanding and preventing long-term complications of mild head trauma. The mission of our research program is to undertake research that will answer fundamental questions on concussion prevention, identification, diagnosis, management, and long-term outcomes and provide the necessary infrastructure to advance concussion knowledge and health care.
The NCAA-DoD Grand Alliance: Concussion Assessment, Research and Education (CARE) Consortium
The CARE Consortium offers the promise of a large-scale, multi-site study of the natural history of concussion in both sexes and multiple sports, that will address the current gaps in our knowledge, and shed light on the neurobiological mechanisms of concussion symptoms and trajectory of recovery. The CARE Consortium is a 30-site investigation enrolling approximately 25,000 military service academy cadets and university student athletes, and capturing 1200 concussions. Participants will receive a comprehensive preseason evaluation for concussion and will be monitored in the event of an injury.
Serum Biomarkers: A Path To An Objective Concussion Diagnosis
The objective of this study is to determine the accuracy of blood biomarkers for diagnosing sports-related concussion and for predicting the duration of post-concussive symptoms. We are enrolling matriculated student athletes at the University of Michigan and at Eastern Michigan University. Pre-season blood samples will be obtained from all athletes participating in high risk contact sports and from control athletes participating in non-contact sports. Additionally, in concussed athletes, blood samples will be obtained after a concussion event. Samples will also be obtained in concussed athletes at 24 to 48 hours after injury and at 2 weeks post-injury. Additionally, blood samples will be obtained from contact-sports athletes without concussion (contact-sports controls) after a game and at 24-48 hours and 2 weeks after the initial draw. Similarly, blood samples will be obtained from athletes participating in non-contact sports (non-contact sport controls) after a game and at 24-48 hours and 2 weeks (+/-3 days) after the initial draw. Blood biomarkers of brain injury will be measured in these samples. Concussed athletes will be examined for resolution of symptoms and return to play. Data from this study will be used to determine the accuracy of blood biomarkers for diagnosing concussion and for predicting the duration of post-concussive symptoms.
Effects of Early Vestibular Rehabilitation Compared to Standard Care in Patients with Dizziness and Balance Disorders after Sport and Recreation Concussion
The purpose of this study is to examine the effect of early vestibular rehabilitation on reducing dizziness, improving balance, and improving the timeline to achieve medical clearance to return to activities such as sports and work activities, when compared to standard care. The findings of this study are expected to provide medical and sports related professionals with appropriate concussion treatment strategies and improve outcomes of patients suffering from concussion.
Evaluating Quantitative Pupillometry in Athletes as a Biomarker of Mild Traumatic Brain Injury
This proposal aims to carefully evaluate Quantitative pupillometry (QP) as a potential diagnostic tool to identify brain dysfunction associated with mTBI. Quantitative pupillometry (QP) is the precise measurement of eye pupil characteristics using a dedicated device known as a pupillometer. A pupillometer delivers a light stimulus to the eye and tracks how pupil size changes in response. The results of this study will provide substantial normative data, will identify differences in QP between acutely concussed athletes and control athletes, and will correlate high-acceleration hits with QP.
Orthostatic Heart Rate after Sport Related Concussion
The objective of this study is to determine if there is an orthostatic vitals signature that is unique to acute concussion that would help with the diagnosis of concussion. Our working hypothesis is that the CNS metabolic changes after concussion alter the autonomic control of heart rate in patients with acute concussion. This change in regulation can be detected as a positive finding on standard orthostatic testing after concussion.
Education Beyond Words: Feasibility of Concussion Discharge Instructions for Children and Adolescents
The purpose of this study is to evaluate efficacy and feasibility of using two-page, gender-neutral comic handout and brief patient education video to improve patients’ concussion knowledge. The aims of this study were to determine the more informative and preferred modality of education; to determine if either modality increased patient and/or caregiver’s knowledge about concussion; and to determine perceived barriers to recovery.
Evaluation of Recovery from Sport Related Concussion
The aim of this study is to quantify success in safely returning athletes to sport following evaluation in the NeuroSport outpatient clinic and completion of a graded return to play process. The aim will be accomplished by retrospectively identifying patients who were cleared for sport participation in the NeuroSport clinic and accessing the frequency at which they were able to return to sport without return of symptoms within 2 weeks of completing the return to play to progression. Return to sport without symptoms within two weeks will be determined by self/parent report by phone survey.
Neurologic improvement with guided physical therapy return to play activities for concussion
The objective of this study is to determine if guided sub-symptomatic threshold physical exertion hastens recovery from sports-related concussion. This is a retrospective chart review of SRC patients from September 2016 through January 2017. Patients who underwent controlled physical exertion while symptomatic within 15 days of their concussion were included in the intervention group. Those who did not undergo this testing, were asymptomatic at time of testing, or who underwent testing after 15 days from their concussion were included in the non-intervention group.
Clinical Features of Chronic Traumatic Encephalopathy
The purpose of the study is to gather clinical data from patients with concerns of suffering from long-term consequences of repetitive head trauma. The preponderance of studies indicates that a small number of concussions with normal recovery does not result in neuropsychiatric or cognitive problems later in life. Epidemiologic studies from the Mayo Clinic did not identify any long-term neurologic problems in those who participated in contact sports, i.e. football and wrestling compared to those who did not participate in these sports. Although there has been substantial media coverage of potential long-term neurologic consequences of participation in American professional football, the incidence of neurologic diseases is uncertain. It is clear, primarily from studies of retired boxers, that some individuals appear to have developed neurologic problems secondary to repetitive mild head trauma in their boxing carriers. Researchers have discovered microscopic brain changes in individuals exposed to repetitive mild head trauma, chronic traumatic encephalopathy (CTE). A diagnosis of CTE is made by looking at brain tissue under a microscope. At this point we do not know what consequences these microscopic changes have during the lives of those diagnosed after death with CTE. While ongoing research efforts attempt to further clarify the association of head trauma exposure, clinical symptoms, and neuropathological changes, we have developed a clinical approach to the spectrum of symptoms thought to be caused by a history of repetitive mild head trauma, traumatic encephalopathy syndrome. This approach can be applied to the evaluation and diagnosis while the patient is still alive.
Baseline Concussion Symptom Score Differences Between Gender, Sport or Level of Play
The objective of this study is to determine if baseline concussion symptoms scores in athletes prior to the start of their season vary by gender, sport, or level of play. Concussion is a clinical diagnosis that includes an appropriate clinical scenario, reporting of symptoms through a post-concussion symptom score list, and an objective neurologic exam. Symptom reporting is considered when determining if an athlete has recovered from their concussion. Recent studies have shown that athletes at baseline can report symptoms at a rate high enough to meet criteria for post-concussion syndrome without any history of concussion. A goal of this study is to determine factors that lead to differences among symptom reporting in distinct athlete populations to aid in clinical decision making.
- Reams N, Eckner J, Almeida A, Aagesen A, Giordani B, Paulson H, Lorincz M, Kutcher J. A clinical approach to the diagnosis of traumatic encephalopathy syndrome: A Review. JAMA Neurol 73(6): 743-9, 2016.
- Swallow J, Joseph J, Willsey K, Almeida A, Lorincz M, Park P, Szerlip N, Broglio S: Online postconcussion return-to-play instructions. Journal of Neurosurgery: Pediatrics 21(1):44-48, 2018. PM29125444
- Alsalaheen B, Bean R, Almeida A, Eckner J, Lorincz M: Characterization of cervical neuromuscular response to head-neck perturbation in active young adults. J Electromyogr Kinesiol 39: 70-76, 2018. PM29413455
- Almeida AA, Lorincz MT, Hashikawa AN: Recent Advances in Pediatric Concussion and Mild Traumatic Brain Injury. Pediatr Clin North Am 65(6): 1151-1166, 2018. PM30446054
- Popovich M, Almeida A, Freeman J, Eckner J, Alsalaheen B, Lorincz M, Sas A: Use of Supervised Exercise During Recovery Following Sports-Related Concussion Clinical Journal of Sport Medicine. (In Press)
- Alsalaheen B, McCloskey K, Bean R, Almeida A, Eckner J, Lorincz M: Women and men use different strategies to stabilize the head in response to impulsive loading: implications for concussion injury risk Journal of Orthopaedic & Sports Physical Therapy. (In Press)