From the sidelines to the front lines, 91原创 research is redefining how concussions are detected, treated, and prevented.
Once, twice, three times a head hit.
How many are too many? How could a traumatic brain injury be diagnosed with minimal or no outward symptoms? What鈥檚 the lasting impact of a mild traumatic brain injury or concussion?
According to the Centers for Disease Control, suffer traumatic brain injuries (TBIs) each year. While most are caused by accidents or falls, many are the direct result of sports injuries. In the last several years, how the brain responds to a concussive head hit and to repeated sub-concussive hits, particularly during a sporting event, has shifted. Researchers at the 91原创 have been at the forefront of concussion and traumatic brain injury discoveries, resulting in updated rules and protocols in sports like soccer and football.
, a professor of鈥痚mergency medicine鈥痑nd of鈥痭eurology鈥痑t 91原创, has dedicated his career to improving the detection and treatment of traumatic brain injuries鈥攑articularly those on the lower end of the severity spectrum, which are more likely to be overlooked. That work has not only benefited the scientific community, but also the people most likely to experience the effects of concussions and other head injuries.
Case in point: Nearly 10 years ago, Bazarian and , a professor of public health sciences at the University, recommended that for high school and college-aged students after a concussion. Their research findings showed that academic problems were more frequent at one week after concussions compared to the students with other types of sports injuries. Today, the CDC鈥檚 provides schools with guidelines on how to work with students after a concussion.
Bazarian continues to work with student-athletes, this time as the leader of a (DOD) to detect subtle neurologic dysfunction after repetitive head hits鈥攎any of which don鈥檛 result in obviously outward injury鈥攁nd to develop treatments to mitigate this dysfunction. He is also a site investigator for , this one supported by the National Institute of Neurological Disorders and Stroke (NINDS), to study the effects of concussions on children, including how this injury impacts the developing brain of youths and adolescents.
And so, study by study, researchers like Bazarian and his colleagues at the University are bringing clarity to the big questions of how trauma and injuries鈥攐ne-off and repeated鈥攃an affect the human brain and overall health and well-being across the lifespan.
The hidden dangers of repetitive head hits
Each hit to the head can compound the one before鈥攕ometimes without symptoms to warn of a growing injury. When a person鈥檚 occupation or activity exposes them to repeated head hits鈥攍ike members of the military or athletes鈥攖hey can experience subtle declines in neurologic function, such as balance, eye movements, and rapid decision making.
These declines in neurological function are not currently detectable by a doctor but can nonetheless impair athletic or military performance and increase the risk of sustaining other injuries. In the long run, such repeated head hits may contribute to the development of serious neurodegenerative diseases or disorders. However, unlike concussion, there is no current standard of care to track, prevent, or treat these hits.
Bazarian is at the front lines of efforts to address that gap.
This fall, he鈥檚 recruiting football players at the Rochester, University at Buffalo, Indiana University, and the Citadel military college. The aim? To track the subtle changes that occur because of sports-related head hits in student-athletes in order to better understand the early indicators of repetitive injuries and what the response protocol should be. The researchers hope to add female soccer players to the research project next year. This would provide critical insight into the impact these head hits have on the female brain, since previous work has only included male subjects.
鈥淲e鈥檙e trying to determine if we can detect and mitigate the acute effects of exposure to repetitive head hits on the brain,鈥� says Bazarian. 鈥淒o these hits alter neurologic functions in a way we can pick up using objective measures suitable for use in low-resource environments like battlefields and athletic fields? If so, what can be done to return neurologic function back to baseline as quickly as possible?”
Bazarian received the aforementioned grant from the DOD鈥檚 Army Medical Research Acquisition Activity (ARMY MRAA), a congressionally directed medical research program, to better understand these repetitive hits to the head, with goals to find ways to detect, prevent injury, and treat them.
鈥淚n a sense, we are borrowing from the field of occupational medicine by applying a brain health monitoring approach to individuals exposed to an environmental factor, in this case repetitive head hits, that increases their risk for neurologic injury,鈥� he says. 鈥淥ur hope is that one day this approach will lower the long-term risk of neurodegeneration in those exposed.鈥�
Blood tests for brain health
Recently, Bazarian joined nearly 100 clinicians and researchers from around the world to propose the first revision to how TBIs are classified since 1974, when the current diagnostic method known as the was established.
The new method of characterizing TBI replaces the standard categories of 鈥渕ild,鈥� 鈥渕oderate,鈥� and 鈥渟evere,鈥� with descriptors in four domains: Clinical, Biomarkers, Imaging, and patient Modifiers (CBI-M). This new characterization approach was recently described in and .
Decades of research in Bazarian鈥檚 lab has produced in how the blood can inform brain health. Specifically, the researchers have identified a technique that measures three brain proteins that can appear in the blood within hours of a brain-injuring head hit鈥攇lial fibrillary acidic protein (GFAP), ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), and S100 calcium-binding protein B (S100B).
The levels of these proteins can provide unique insight into the magnitude of brain injury that was not previously available to clinicians. High levels can predict six-month mortality and incomplete recovery, while low levels indicate an extremely low risk of a brain bleed on CT scan, which would inform whether a CT scan is necessary.
In 2018, the Food and Drug Administration approved a blood test called the Banyan Brain Trauma Indicator.鈥疶he University鈥檚 Medical Center was a site for , with Bazarian as the lead author of a related study that appeared in the journal The Lancet Neurology. That work proved influential as part of the FDA鈥檚 decision to approve the first blood-based biomarkers of traumatic brain injury in the United States.
Recruiting subjects for this research, Bazarian and his fellow researchers work with 91原创 student-athletes and patients in the Strong Memorial Hospital Emergency Department. They also collaborate with , an associate professor of emergency medicine at 91原创, to follow these subjects through their recovery. Beyond the initial diagnosis, a person is generally monitored based on what symptoms they have鈥搒ubjective markers like patient-reported symptoms such as headaches, nausea, or light sensitivity.
鈥淣ot knowing what is happening in the brain can affect an individual鈥檚 quality of life in the long term,鈥� Merchant-Borna says. 鈥淐oncussion recovery can be difficult to track, and symptoms often dissipate before the brain is fully healed.鈥�
The 91原创鈥檚 concussion research is more than a series of studies鈥攊t鈥檚 a sustained effort to safeguard brain health across the lifespan. In pushing the boundaries of what medicine can know and do, 91原创 is leading the way toward a future where the complex dangers of head injuries are better understood, better treated, and ultimately, better prevented.
