The National Institute of Health
discovered that more than one million mild traumatic brain injuries occur each
year within the United States. Professionals take these cases seriously because
the human brain is the command center of the body. Although it is surrounded by
a protective, bony shell and fluid that has the ability to absorb impact, the
brain is composed of soft, sensitive tissues. Of the one million mild traumatic
brain injuries, more than half occur in children participating in organized
athletic events. Common symptoms of
concussions, a form of mild traumatic brain injury, include: loss of
consciousness, headaches, amnesia, nausea, dizziness, confusion, balance and
memory impairment, and light sensitivity, along with many others. With a recent
dramatic increase in diagnosed concussions in athletes, researchers have set
out to understand the effects of repeated head trauma, while also discovering
potential biomarkers to properly detect brain injury.
Neurological Testing for Concussions. Digital Image. http://espn.go.com/espn/otl/story/_/id/8297794/neuropsychological-testing-concussions-not-panacea
Bernick
et al. gathered two-hundred and twenty-four fighters and twenty-two controls to
participate in the Professional Fighters Brain Health Study (PRBHS). After
gathering how many years each participant had engaged in fighting and how many
fights per year, they underwent computerized cognitive testing and volumetric brain
MRI. Cognitive testing examined memory, finger tapping, and symbol digit coding
skills, while the MRI acquired the volumes of each structure in the brain. The
goal of this experiment was to study the relationship between exposure to
repeated head trauma and measurements of brain structure and function, along
with cognitive performance.
They
discovered that repetitive head trauma is associated with lower brain volumes and
lower processing speeds among the studied professional fighters. The MRI showed
lower volumes in various structures within the cortical and subcortical area,
particularly the thalamus and caudate. Therefore, brain function is vulnerable
to volumetric loss. The thalamus relays sensory and motor signals to the
cerebral cortex, therefore if affected, neurological functions may be
diminished. A blow to the head also results in axonal injury in white matter
tracts, which can lead to possible neuronal loss in subcortical grey matter
structures. In other words, if signals are unable to travel down an axon of a
neuron, then the cell all together is almost incapable of sending information.
In
terms of the cognitive aspect of this study, processing speed was correlated
with reduced volume in brain structures. Also, processing speed was lower in
participants who obtained higher Fight Exposure Scores (FES). FES accounts for
cumulative number of fights and intensity of exposure (number of fights per
year). It is possible that this test will provide a useful means when
determining future cognitive impairment and/or future retirement plans
regarding neurological damage in sports. One important future implication
Bernick et al. suggested was potential biomarkers of brain injury, which could
provide advances in detecting head trauma in athletes and all humans.
Pham
et al. recently discovered plasma soluble cellular prion protein (PrPC)
as a potential reliable biomarker in rodents. A biomarker has the ability to
assist in detection of brain injuries, especially when no obvious physical injury
is noticeable. This scientific advancement has the potential to properly
diagnose humans who have experienced a form of head trauma.
Athletes
and non-athletic students between the ages of eighteen and thirty year-olds
were recruited and evaluated. Normal values for the plasma soluble PrPC
were recorded in both gendered participants. Pham et al. determined plasma
soluble PrPC were significantly higher in students who were
confirmed to have experienced a concussion than the normal values in young
adults.
With
that being said, the study proposed that this biomarker could potentially be
used for neuroinflammation and encephalitis, also known as acute inflammation
of the brain. Although it is prominently found in the central nervous system,
which includes the brain and spinal cord, recent evidence indicates that PrPC
has that ability to cross the blood brain barrier in a bidirectional manner.
Therefore, soluble PrPC concentrations can be determined in multiple
locations within the central nervous system. The study also noted that there
were no significance between genders and different age groups of young adults.
This means there is no gender and age variation in human plasma PrPC
concentrations, which supports the conclusion that it is indeed an ideal
biomarker for brain trauma.
The
future of sports medicine is focused on head trauma in athletes as high-contact
sports experience an increase in sports-related concussions each year. Bernick
discovered the association between repeated head trauma among professional
fighters and the result of smaller thalamic volumes and slower processing
speed. Pham et al. then revealed a potential biomarker in determining
sports-related concussions, plasma soluble cellular prion protein (PrPC).
Both studies have further developed a clinical diagnostic tool to assist
clinicians in diagnosing concussions and return-to-play decision making among
athletes.
References:
Bernick, C., Banks S.J., Shin W.,
Obuchowski N., Butler, S., Noback M., Phillips M., Lowe M., Jones S., Modic M.
Repeated head trauma is associated with smaller thalamic volumes and slower
processing speed: the Professional Fighters’ Brain Health Study. Br J Sports
Med 0:1-6 (2015).
NIH News in Health. A bang to the
brain: what we know about concussions. National Institute of Health. (May
2013).
Pham N., Akonasu H., Shishkin R.,
Taghibiglou C. Plasma soluble prion protein, a potential biomarker for
sport-related concussions: a pilot study. PLoS ONE 10(2): e0117286 (2015).
I thoroughly enjoyed this blog entry as it covered a topic that I and many others are interested in. Only recently have repeated concussions and their consequences come to the forefront of discussion in organzied sports. With all the findings about how detrimental repeated head trauama and concussions are, it still seems like not a lot is being done to help the cause. Many professional athletes, especially boxers, football players and hockey players have severe depression because of the numerous concussions that went undiagnosed or rushed back in to competing to soon.
ReplyDeleteThe biomarkers you mentioned in your blog is new information to me and I'm happy to hear about the progression. However, I still feel as though the real progression will be coming when people understand, raise awareness and not rush kids and athletes back into their sport too soon.
I think this is a really great post and particularly relevant to Colgate and our division I athletes. I think recently people have begun to take concussions and their consequences more seriously. I think symptoms of brain trauma are not as obvious as other injuries, such as a broken ankle, and it is important to have some marker to assess potential injury. I wonder if screening this biomarker could be implemented in yearly physicals for athletes to determine whether they are safe to play a contact sport.
ReplyDeleteI think this post is really interesting and has important implications for student athletes! One thing I am wondering is whether the levels of PrPc stay high for a long period of time after a concussion or if they go back to normal after the injuries have improved. It would be interesting to see if this biomarker could be used to determine if an athlete has recovered from a concussion and is well enough to play again.
ReplyDeleteI liked how this article focused on a potential bio marker for brain injury. As someone who tries to keep up on brain injuries and how to prevent them it is fascinating that there is a possible ideal bio marker for brain injury that would make it easy to diagnose and treat future brain injuries.
ReplyDeleteI think the recent focus on concussions in athletes is very interesting and also very scary for those who have played sports for many years. This research has helped shaped policies that ensure athletes recover from head injuries before playing again. I often hear about new studies focusing on how detrimental concussions are, so it is scary to think only a few years ago an athlete could get a concussion and be told it was fine to keep playing the next day. This research is very important in the lives of children who are currently playing contact sports because it may help shape new rules in order to better protect the athletes. Although it may be too late to reverse the damage done to long time fighters, we can still use it to prevent future generations from being exposed to these types of preventable injuries.
ReplyDeleteWhile organized sports have many clear benefits for children and young adults, more research seems to be surfacing about the harm of how competitive these sports are coming. Student athletes are frequently injured, not only with concussions, but with a whole host of other injuries, and like others have mentioned, these student athletes and their coaches are eager to get them back into competition and proper recovery does not always occur. While sports keep students fit and encourage many positive traits such as cooperation and good sportsmanship, are sports becoming more harmful as they become more competitive. What are the long term effects of youth constantly pushing themselves to their physical and mental limits?
ReplyDelete