A few members of the Concussion Research team, left to right: Kristy Arbogast, Christina Master, Olivia Podolak and Ronni Kessler
According to the Centers for Disease Control and Prevention, an estimated 1.6 million to 3.8 million concussions occur in the United States each year. Of those, 65 percent are estimated to occur in the pediatric and adolescent population. Although concussions dominate the sports literature, half of those occurring in the 11- to 15-year-old population are not sports-related. Therefore, concussions in children are not just a sports injury; they are a major pediatric public health problem.
CIRP, in collaboration with CHOP's Sports Medicine and Performance Center, is building a broad portfolio of concussion research to advance the field’s understanding of child and youth concussion and to fill in gaps in knowledge that hinder development of better prevention and treatment strategies. Specifically, we focus on rigorously describing concussion across the pediatric age range and clinical settings, providing data and methods to develop engineering and behavioral prevention strategies, improving diagnostic tools and how we manage recovery. With this information the field can advance targeted interventions to prevent concussion and optimize treatment to accelerate recovery.
Areas of Concussion Research at CIRP:
- Objective Measures for Concussion
- Improving Pediatric Concussion Management
- NFL Engineering Roadmap
- Foundational and Completed Concussion Research Projects
- More about Concussion Research at CIRP
Current Concussion Research Projects:
Integrative Science to Advance Pediatric Concussion Diagnosis and Treatment --This 4-year research project aims to increase our knowledge of the neurological health effects of repeated head impacts for middle school and high school-age youth involved in sports, develop objective biomarkers to identify the functional deficits associated with youth concussion, advance our basic science understanding of the electrophysiology of concussion and, lastly, test the effect on brain function of a promising therapeutic designed to accelerate recovery from concussion. Principal Investigators: Kristy Arbogast, PhD (overall PI), Christina Master MD, Akiva Cohen, PhD, J. Christopher Edgar, PhD; Catherine McDonald PhD (Penn School of Nursing), Douglas Wiebe PhD (Penn School of Medicine), Gary Beauchamp PhD (Monell Chemical Senses Center) Funding: Pennsylvania Department of Health
- Quantitative Assessments for Sports-Related Concussion -- This five-year project integrates neuroscience, bioengineering and clinical protocols that will involve instrumenting athletes on the field, using animal models in the laboratory and in-depth clinical observation of patients with concussion with a goal to develop a suite of quantitative assessment tools to enhance accuracy of sports-related concussion diagnoses, with a focus on objective metrics of activity, balance, neurosensory processing including eye tracking, as well as measures of cerebral blood flow. These could provide better guidelines for estimating both recovery time after a concussion and when young athletes can safely return to play. Researchers are examining the role of factors such as repeated exposures and direction of head motion. In addition, they are looking at sex-specific data to see how prevention and diagnosis strategies need to be tailored differently for males and females. Principal Investigators: Kristy Arbogast, PhD, Christina L. Master, MD, Susan Margulies, PhD; Funding: National Institute of Neurological Diseases and Stroke
Pennsylvania Consortium on TBI (PACT)-- A Collaboration between CHOP Minds Matter Concussion Program, Penn Center for Brain Injury and Repair, University of Pittsburgh and Moss Rehabilitation Research Institute, this study aims to improve diagnosis, management and treatment of TBI using techniques that can be utilized to identify neuropathologically and neurophysiologically relevant brain changes after traumatic brain injury (TBI) from mild to severe. Team members from CHOP aim to determine the utility of serum blood biomarkers in establishing a diagnosis for mild traumatic brain injury or “concussion”. In particular, the role and extent of diffuse axonal injury in concussion outcomes are being examined, with hopes of potential utility to be detected in the same individuals who will have persisting neurocognitive defection following concussion. Principal Investigators: Douglas H. Smith, MD (PI) Perelman School of Medicine at the University of Pennsylvania, Christina L. Master, MD (CHOP Site PI), Kristy Arbogast, PhD (CHOP Co-I); Funding: Pennsylvania Department of Health
Visio-Vestibular Markers for Concussion -- There is a growing body of evidence that concussion can impair eye movement. Over a series of research publications, CIRP’s Minds matter researchers describe these deficits as seen in clinical settings and their association with prolonged recovery from concussion. Researchers have also been testing the utility of a visio-vestibular exam to detect deficits in concussed pediatric and adolescent patients and the use of automated eye tracking technology to objectively measure these deficits. They have learned that such clinical tools are both effective and feasible and important for diagnosis and recovery. Principal Investigators: Christina L. Master, MD, Daniel Corwin, MD. Funding: National Institutes of Health,Center for Disease Control and Prevention, NCAA, Department of Defense
- Concussion Assessment Research Education (CARE) Consortium Longitudinal Clinical Study — This is a multi-site concussion consortium in which varsity athletes at participating colleges are assessed at baseline (pre-season) and then if they sustain a concussion, followed longitudinally through their recovery. CHOP serves as a CARE study site in collaboration with the University of Pennsylvania (Penn). As of September 2016: CHOP is enrolling and conducting baseline assessments on approximately 1,000 Penn varsity student-athletes over the course of the academic year. Those who experience concussion(s) will complete immediate post-concussion and follow-up assessments. Site Principal Investigator: Christina L. Master, MD; Funding: NCAA-U.S. Department of Defense Grand Alliance
Genomic Markers for Concussion— Understanding what populations of children may be at increased risk for concussion, or may be more likely to have prolonged recovery, could allow for more targeted interventions that may help further reduce concussion incidence and severity. The primary aim of this project is to determine if variations in the human genome are associated with concussion incidence and/or outcomes-- specifically, the association between genomic variation and phenotypic outcomes in a cohort of patients prospectively identified with new concussion. In collaboration with CHOP’s Center for Applied Genomics (CAG) we are conducting a retrospective analysis on kids who have had genetic testing conducted as part of another study at CHOP and have a concussion diagnosis. We are also evaluating the feasibility and logistics of prospectively collecting this genetic information at the time of concussion diagnosis. Principal Investigator: Kristy Arbogast, PhD; Funding: Clinical and Translational Research Award (CTSA), Children’s Hospital of Philadelphia Research Institute
Leveraging Electronic Health Records (EHR) for Concussion Surveillance — This project leverages the single, linked electronic health record (EHR) system at CHOP to expand traumatic brain injury (TBI) surveillance and research, with a focus on concussion, and to assess whether EHR-based initiatives can improve TBI management. The line of concussion research explores the points of healthcare entry and number of types of providers seen, as well as the characteristics of and outcomes for patients who experienced one vs. multiple concussions as well as those with other co-morbidities. Through an analysis of patients with concussion seen at CHOP, one study describes the diversity of pathways of clinical care for children diagnosed with a concussion. Read the study that shows the vast majority of concussed children and youth who have a primary care provider enter the healthcare system through primary care. One-third are under age 12 years. (View an infographic about this study). Additionally, this project used EHR, as well as surveys of CHOP providers, to evaluate the impact of implementing a standardized concussion management program that used EHR diagnostic and management support tools. Barriers and facilitators to use of these tools were determined using survey methods. Read the study that used the EHR to evaluate how such a standardized system facilitated the timely and accurate provision of return to learn/play instructions. Lastly, investigators used the linked EHR to: categorize the broad mechanisms of injury for concussion sustained by youth 0-17 years; quantitfy the proportion of concussions due to sports and non-sports activities (70% vs 30%) respectively; and describe the distribution of sports concussion by activity level of contact. They found that only 40% of concussions were from full contact/collision sports and that the proportion of concussion injury from sports and recreation was highter among older children. Read this study. View an infographic about this study. Principal Investigators: Kristy Arbogast, PhD, Christina L. Master, MD; Funding: Centers for Disease Control and Prevention
- Through its Co-Director Kristy Arbogast PhD, CIRP plays a leadership role in the NFL’s Engineering Roadmap-- helping to set and oversee the implementation of this initiative’s research plan. In 2016, the League pledged $60 million over the next five years to improve the understanding of football biomechanics and to create incentives for small businesses, entrepreneurs, innovators and helmet manufacturers to develop new protective equipment. The primary purpose of the Engineering Roadmap is to stimulate innovation in a very open and transparent way to improve the safety of the game. This body of work will provided needed understanding, at a very detailed mechanical level, the scenarios in which injuries are happening and provide the data to direct the development of evidence-based innovations.
Institute of Medicine Report on Sports-Related Youth Concussion -- On October 30, 2013, the Institute of Medicine (IOM) released a report, Sports-Related Concussions in Youth: Improving the Science, Changing the Culture, which reviews the state of the science on sports-related concussion in children and youth ages 5 to 21. CIRP’s Co-Director and Director of Engineering Kristy Arbogast, PhD was a member of the 17-person expert committee that reviewed the science and created the evidence-based recommendations to improve concussion prevention, diagnosis, and management Read the full IOM report. Read Dr. Arbogast’s blog post on the science behind whether helmets protect kids from concussions.
- Characteristics of Concussion in Youth — This line of concussion research sought to capture and describe the diversity and variability of the pediatric concussion patient population at CHOP and more broadly. By doing so, clinicians are better equipped to recognize and treat specific concussion symptoms as well as predict recovery outcomes. Principal Investigators: multiple; Funding: multiple
- Minds Matter: Concussion Care at CHOP –- This program was a two-year initiative to develop and refine a state-of-the-science standardized pediatric concussion management program across all CHOP departments that diagnose triage and treat concussion. These include primary care, sports medicine, emergency medicine, neurology, trauma and afterhours triage call center. Impact evaluation is underway leveraging CHOP’s EHR and provider surveys. Principal Investigators: Kristy Arbogast, PhD, Christina L. Master, MD, Matthew Grady, MD; Funding: Department of Pediatrics Chair's Initiatives, Children's Hospital of Philadelphia
- Helmet-based Sensors -- This concussion research was focused on evaluating the accuracy of sensor systems designed to be implemented for helmeted and non-helmeted sports to measure the kinematics of head impact of athletes in real sports settings. Such sensors are key to research efforts to identify thresholds for injury-causing impacts across the pediatric age range and across a range of real world impact conditions. Principal Investigators: Mari Allison, PhD, Kristy Arbogast, PhD; Funding: National Science Foundation
- Concussion Recovery App: Use of Ecologic Momentary Assessment to Track Symptoms -- With this concussion research study, researchers and clinicians tested the feasibility of using Ecologic Momentary Assessment (EMA) to help patients and clinicians assess cognitive and physical activity as well as concussion symptoms in real-time during recovery after pediatric concussion. The mobile-device concussion recovery app explored in this research is now in CIRP's current research protocals. Principal Investigators: Douglas Wiebe, PhD, Christina L. Master, MD; Funding: Penn Medicine Translational Neuroscience Center
- HIT HEADS Trial of Dietary Supplements-- HIT HEADS stands for “Head Injury Treatment with Healthy and Advanced Dietary Supplements.” Clinician-researchers have worked to increase therapeutic options for treating concussions. One line of inquiry concerns the potential role for dietary supplements. The HIT HEADS was a randomized, placebo-controlled, double-blinded, therapeutic exploratory clinical trial of dietary supplements in the treatment of sports-related concussion. The dietary supplement explored in this research is now in CIRP's current research protocals. Principal Investigator: Akiva Cohen, PhD; Funding: Dana Foundation
- Concussion Registry Development– The initial objective of this concussion research was to test the feasibility of creating a comprehensive registry of patients 5-21 years old diagnosed with concussion within the CHOP Care Network. Data capture how concussions are assessed, diagnosed, and treated. Tasks involve a review of the current data fields in CHOP’s electronic health records for capturing subject concussion information as well as data collection from patients presenting for new concussion evaluation. Patients were recruited from CHOP specialty care outpatient clinics, including sports medicine and orthopedics. By capturing a standardized and comprehensive data set on every child with concussion, we are forming a valuable resource which can be utilized to answer other important questions about prevention, diagnosis and management of this common injury. Principal Investigator: Kristy Arbogast, PhD; Funding: Clinical and Translational Research Award (CTSA), Children’s Hospital of Philadelphia Research Institute
CIRP Concussion experts frequently blog about latest developments on CIRP's Research in Action Blog. Read the youth concussion-related articles.