Screenshot from an informational video by UAB News about the research surrounding concussions. (Video by UAB News).Mark Linn - Staff Writerquiaego@uab.edu
The risk of concussions in heavy contact sports, particularly football, is increasingly being brought to the public’s awareness. However, there are no medical tests to reliably diagnose concussions and few methods of treatment.
To address these problems, UAB researchers from across several disciplines are partnering with coaches and athletes to find better ways to diagnose, treat and prevent concussions.
Concussions are generally defined as mild traumatic brain injuries, but the exact definition can vary. The definition of concussion used by UAB's Sports Medicine staff is the one adopted by the Fourth International Conference on Concussion in Sport, which took place in 2012.
According to that definition, concussions can be caused by either a direct blow to the head, face, neck or elsewhere on the body, with an “impulsive” force that is transmitted to the head. The injury typically results in the rapid onset of neurological impairment, but in some cases, symptoms can evolve over minutes or hours. Signs of impairment can include clumsy movement, double or blurry vision and memory problems. Concussions can occur even without a loss of consciousness.
“Diagnosing concussions on the field is very tricky, to say the least,” said Mike Jones, the assistant athletic director for UAB Sports Medicine and head trainer. “The hardest part is, we all know they all want to be out there, and some of them have knowledge of what concussions are and some of them really don't.”
According to Jones, diagnosing a concussion on the field requires a thorough questioning of the athlete, as well as knowledge of how the athlete would typically respond. Athletes are required to perform basic cognitive tests such as counting months backwards and solving simple math equations. A football player suspected of suffering from a concussion is removed from play and evaluated by Jones or the team physician. The player cannot return to play for 24 hours, according to state law. Jones said that recovery times can vary.
“We've had some that were OK to play the next day and we've had some that have missed months,” Jones said. “It's a very delicate injury and no two concussions are alike, and that's what a lot of people don't understand.”
Richard Marchase, Ph.D, the vice president for Research and Economic Development, claims that the way that most referees and sports associations are treating concussions is a “huge” step forward. “The fact that, if you really have what might be a concussion inducing injury, it's not just up to the coach anymore whether you're sent back into the game or not but there really are medical [analyses] that are already being carried out that help determine whether or not you should go back,” Marchase said.
One avenue of research is being pursued by the UAB School of Optometry. The school is working with the athletics program to perform eye exams on student athletes in the hopes of establishing a baseline in the case of a possible concussion to improve on-field diagnoses.
“In the case of the vision science tool, one of our hopes was that there would be a much more accurate on-field assessment,” said Marchase. “So that it would be possible to link eye responses [to concussions], than is now the case, when it is basically a cognitive discourse to try to determine is a trauma-inducing injury has occurred.”
According to Marchase, the vision tool could be a “real time analytic approach.”
Designing a better helmet to lower the risk of concussions is another ongoing project at UAB. Dean Sicking, Ph.D., is a professor at the UAB Department of Mechanical Engineering who Sicking has also created an 80-foot track in his lab featuring high-tech dummies mimicking football players at each end. By controlling the speed and position of the impact, researchers can re-create the most common types of impacts and test a variety of helmet designs.
Sicking has been working closely with UAB athletics to develop a new helmet design.
“Right now the material we have right now for the shell will basically help absorb a lot of the energy that occurs between the collusion of two helmets,” Jones said. “It's very promising. The results we've seen in the lab and testing, we really really feel it will chance concussions in football over the next few years.”
Sicking and his lab are also using special software to study thousands of helmet-to-helmet impacts in football games.
“We have Dr. Sicking's work where Dr. Sicking, via using high performance video analysis, would be able to get real time data on the kinds of impacts quantifying the kinds of impacts that are occurring. For instance, if impacts are over the threshold, there might be an automatic waring that that player needs to be examined because he's taken a hit of, whatever it is, a 100 G's, I'm not sure that's the right number but whatever the that says that hit is significant enough that that person needs to be examined.”
This means that there could be a video-defined threshold that would alert coaches and on-the-field physicians that a violent, concussion-causing hit has taken place and that further action needs to be taken before the injured player is allowed to re-enter the game.
Another focus of the research is on decreasing rotational acceleration, something that, according to Marchase, investigators see as critical to the onset of concussion injuries.
“By rotational acceleration I mean, for instance, taking a hit to the face mask that tries to twist your head very rapidly to the left or to the right,” Marchase said.
Although James M. Johnston Jr., M.D., a UAB pediatric neurosurgeon and co-director of the concussion clinic claims that the researchers’ understandings of concussions are still “primitive”, according to a UAB news article, Marchase spoke of a strong team of researchers.
“We have investigators in neurology and pediatrics and vision sciences all of whom are very interested in the problem of athletic concussions and already have a very strong effort going forward to ensure that both children and adults that are suffering from traumatic brain injuries from sports injuries are going to be appropriately treated as they look to going back to the field,” Marchase said.
