In the US, there are more than four sports-related traumatic brain injuries every minute. There is emerging evidence that sports-related concussion (SRC) can affect academics, behaviors, and neurocognitive processes, such as working memory, concentration, processing speed, and eye and motor function.
A recent Institute of Medicine report on sports-related concussions in youth (read related blog post), revealed how little is known about concussion in the young brain and called for urgent attention to determine the incidence of SRCs in boys and girls by sport and demographic; research to identify unbiased, sensitive prognostic and diagnostic metric and marker; longitudinal studies to determine outcomes; and to delineate age- and sex-related biomechanical determinants of injury risk.
Objective Translational Multi-domain Early Concussion Assessment Study
This research project focuses specifically on developing a suite of quantitative assessment tools to enhance accuracy of sports-related concussion diagnoses, with a focus on eye-tracking and measures of cerebral blood flow. The study will determine sports settings with highest impact exposures and integrate across animal (porcine) and human studies to relate rapid head rotation magnitude and direction to short-term outcomes. These data will provide prognoses of the time-to-recovery and safe return-to-play for youth athletes. This study will also look at sex-specific data to see how prevention and diagnoses strategies need to be tailored for males and females.
Over the course of the 5-year study, researchers will pursue the following aims:
Aim 1- an unbiased numerical assessment suite for SRC will be developed and validated. Objective metrics include assessments of balance, oculomotor function, visual and auditory processing, and sleep. Researchers will determine if these metrics or certain combinations of these metrics identify the presence of SRC with high sensitivity and specificity and are predictive of days-to-clearance for sports. The research team will then validate the findings in a separate cohort.
Aim 2 – Because the Aim 1 objective metrics are nonverbal and effort-independent, we are “translating” their use to an animal model of TBI where human-like measures of physical, cognitive, and sleep deficits are associated with SRC in piglets after rapid controlled head rotations. In Aim 2, we use this juvenile porcine TBI model to determine SRC mechanisms by relating the influence of sex and load frequency, magnitude and direction on neuro-function, biomarkers and neuropathology. Both single rapid head rotations will be studied as well as a multiple sub-concussive rotations. In this line of study, by developing new technologies to translate human outcome metrics to animals, we provide a human-like platform to develop and test injury treatments in the future.
Aim 3 – The insights from Aim 2 will be translated from animals to teens, where head impact sensors are used to quantify biomechanical load exposure by sport and sex, and relationships between load exposure and neuro-functional metrics using the numerical assessment suite developed in Aim 1. This will provide new knowledge regarding high-risk biomechanical settings for the young brain.
Of note, the study will use BOTH male and female high school athletes and piglets in a deliberately parallel study design to determine optimal SRC assessments and identify mechanistic relationships between sex, energy loading conditions, and SRC symptoms.
Funding: National Institutes of Health (National Institute of Neurological Diseases and Stroke)
Read Philadelphia Inquirer article "Concussions in Teen Athletes: Making Sure the Brain is Okay Before Getting Cleared to Play"