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Newswise — BIRMINGHAM, Ala. – With the release of the controversial movie, "Concussion", many questions arise for parents with children playing contact and noncontact sports. Concussion diagnosis and treatment is an evolving medical practice that seems to be gaining traction each year. At the University of Alabama at Birmingham, experts are working together to research and develop better equipment, more accurate diagnosis and appropriate treatment for those who have suffered head trauma.
To schedule an interview, contact Alicia Rohan at 205-975-7515 or [email protected]. UAB has a broadcast studio available for remote, live or taped television and radio interviews.
Current research coming out of the UAB and Children’s of Alabama Concussion Task Force include:
Katherine Weise, O.D., MBA is part of a team of UAB researchers investigating concussion patients that recover on their and suffer lingering symptoms for weeks or months, as well as test therapies that could affect recovery time in the UAB Vestibular and Oculomotor Research Clinic (VORClinic) located in the UAB School of Optometry.
The clinic, one of only a handful nationwide, focuses on the neural systems that control balance and eye movements — which are often disrupted after head injuries.
The centerpiece of the facility is a high-torque, high-speed rotating chair; as participants spin in total darkness, they are asked to track small targets or follow large random dot patterns. The researchers record their eye movements with infrared cameras in order to detect subtle signs of brain damage.
Repeated tests could determine how long it takes for a participant to fully recover from a concussion, or reveal the effects of potential new therapies. (Follow 10-year-old Lewis Rand’s experience in the VORClinic in this story.)
Claudio Busettini, Ph.D., associate professor in the Department of Vision Sciences, who directs the VORClinic with Jennifer Christy, P.T., Ph.D., associate professor in the Department of Physical Therapy are using the VORClinic to search for early, measurable physical signs, or biomarkers, that are linked with prolonged concussion symptoms in patients. At the moment, athletes begin the “return-to-play” and “return-to-learn” (that is, school) protocols when they no longer report having symptoms.
“Objective biomarkers are especially important for athletes and young children who might not be able to properly communicate their problems,” said Busettini. “The lack of reliable measures may delay their return to learning and sports even if they have fully recovered, or allow their return while they are still recovering, when another hit can have devastating effects.”
Drew Davis, M.D., an associate professor in the Department of Pediatrics, along with Weise and Christy, recently presented information on the VORClinic’s biomarker research at the American Congress of Rehabilitation Medicine conference in Dallas, and met with “tremendous interest,” said Davis. “Everyone’s very excited about this work.”
Mark Swanson, O.D., MSPH, and other members of the VORClinic team are using handheld instruments called pupillometers, which detect subtle changes in pupil size and reactivity to light during a quick 30-second test. Previous research has suggested that concussions alter this response.
The VORClinic team is now working with community football programs and other youth sports organizations around the state to monitor players over the course of a season. They hope to detect patterns that point to damage buildup, giving coaches warning that a player needs to rest.
Sara Gould, M.D., MPH, an assistant professor in the Department of Emergency Medicine and co-director of the concussion clinic is working on another study from the same team, comparing pupillometer readings from healthy players with readings from players who have recently experienced a blow to the head. If there are significant differences between the two, “we may be able to identify kids who have concussion with a simple test right there on the sidelines,” said Gould.
Laura Dreer, Ph.D., an associate professor in the Department of Ophthalmology and director of Psychological and Neuropsychological Clinical Research Services at UAB looks at the the timing around a student-athlete’s return to a regular academic schedule.
Dreer is working with a number of collaborators on the Alabama Concussion Task Force to develop the first evidence-based protocols to guide doctors and parents. Her preliminary data show that “parents and teachers are eager for more education and training in strategies to keep kids safe” during their recovery, she said.
Several studies now underway at the concussion clinic are seeking to better understand factors that enhance and inhibit academic success post-concussion, Dreer adds. “This information will inform intervention strategies desperately needed for schools, physicians and sports teams, along with parents and children,” she said.
Candace Floyd, Ph.D., associate professor and director of research in the Department of Physical Medicine and Rehabilitation is studying a novel compound that minimizes post-concussion damage.
Concussions begin with mechanical injury to cells, explains Floyd. But the vigorous immune response to those damaged cells, including oxidative stress and inflammation, causes a heavy amount of additional cell death. These “secondary effects” make the problem worse.
The compound, known as a catalytic oxidoreductant, was originally developed by investigators at Duke University and characterized by Hubert Tse, Ph.D., assistant professor in the Department of Microbiology, to combat rejection in organ transplantation. Because it works to lower oxidative stress, Floyd and Tse hypothesized that the compound could also reduce the secondary effects of concussion. So far, results have been promising, Floyd says.
The long-term goal is to develop a drug that could be administered on the sidelines by athletic trainers immediately after a blow to the head, perhaps as an aerosol spray.
James M. Johnston Jr., M.D., a UAB pediatric neurosurgeon and co-director of the concussion clinic says that patient visits increased sixfold at the UAB Sports Medicine Concussion Clinic at Children’s of Alabama since 2011, and now average 350 per year. A new Alabama law passed in 2011 required that any athlete suspected of having a concussion had to receive a physician’s clearance before returning to play.
The concussion clinic is open year-round; football season is the busiest time, but spring soccer and lacrosse seasons also see a rise in patients, he says.
“Because we have such a high clinical volume, we can play a major role in research efforts at UAB,” Johnston said. A large study led by Johnston and his colleagues at the clinic, published in the Journal of Neurosurgery: Pediatrics in 2014, documented the improved quality of care for patients after the establishment of the multidisciplinary concussion program at UAB and Children’s in 2011.
It also outlined the extensive education and outreach efforts from the clinic, which include training for rural care providers and an annual concussion conference. These can serve as a model for other states, Johnston says.
In a new study in the same journal, Johnston and co-authors use the clinic’s extensive patient data to describe factors that are associated with long-term concussion symptoms, including a history of previous concussion and female gender.
The clinic is also a major source of patient referrals for concussion studies in the VORClinic and elsewhere at UAB. “Research has always been a big part of the vision” for the clinic, said Johnston. “Patients and their families are eager to be involved to help answer these questions.”
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