Preventing Concussions in Young Athletes: March is Brain Injury Awareness Month

By DAWN TORTAJADA

Blood test may identify concussion, new study shows

By ANDREW JONES

Physicians may be able to tell if a person suffered a concussion by performing a simple blood test, according to a new study by University researchers. The team of brain injury specialists, which included professors and physicians from Alpert Medical School, pinpointed a set of biomarker proteins whose levels change in a person’s blood following a concussion — also known as a mild traumatic brain injury. The study was published in the March issue of the Journal of Neurotrauma.

The researchers — with the goal of developing a routine diagnostic test for concussions — studied emergency room patients who had suffered from a mild brain injury within the last 24 hours, according to the study. The scientists performed immunoassays on the patients’ blood samples to measure the levels of various proteins in the blood. Using information from previous animal studies, the researchers assessed the blood levels of 18 proinflammatory proteins to determine whether their concentrations also change in humans who sustained a concussion, said Adam Chodobski, associate professor of emergency medicine at the Med School and senior author of the paper.

They found that in the hours following a concussion, the concentration of four of the assessed proteins significantly changed in the blood of the participants with mild traumatic brain injuries compared to that of the control patients. While the proteins galectin, matrix metalloproteinase-9 and occludin were all shown to increase within eight hours following mild traumatic brain injury, the protein copeptin decreased in the same time frame, according to the study.

The study included two control groups: one of uninjured subjects and another of patients who had suffered long bone fractures. The second group allowed researchers to demonstrate that the protein levels do not change in any type of traumatic injury, Chodobski added. But the biomarkers identified in the study cannot detect a concussion with equal precision if the patient has another injury in addition to a concussion, he added.

“These biomarkers can establish with high accuracy the difference between an uninjured individual and a patient with isolated concussion,” Chodobski said.

The project, which was funded by donor Diane Weiss and the Department of Emergency Medicine, implemented a novel biomarker method, Chodobski said. The traditional biomarker approach involves examination of proteins released by dying brain cells after injury, but the researchers working on this study analyzed the proteins produced by brain cells that were still alive, he said, adding that he hopes it will be used more prevalently following this study.

The research team is interested in commercializing the assay used in the study, said Joanna Szmydynger-Chodobska, assistant professor of emergency medicine and a co-author of the paper. The assay could one day be implemented in emergency rooms as a quick and robust way to diagnose concussions, she added. The team has already filed for a patent and is now seeking additional funding to perform a larger-scale study and develop the biotechnology.

Concussions among young athletes should be a concern for parents, coaches and lawmakers

The Issue

The rate of concussions among U.S. high school athletes more than doubled between 2005 and 2012, according to an Ohio State University study. More than 4,000 concussions occurred in athletes in boys’ football, boys’ and girls’ soccer, girls’ volleyball, boys’ and girls’ basketball, boys’ wrestling, boys’ baseball and girls’ softball. High school football saw the highest concussion rate.

Chris Borland, formerly of the San Francisco 49ers, isn’t the only young man walking away from football.

University of Michigan starting center Jack Miller recently cited concussion concerns when announcing he no longer would play the sport.

“I know I’ve had a few and it’s nice walking away before things could’ve gotten worse,” Miller told ESPN. “My health and happiness (are) more important than a game.”

He says he didn’t report a couple of concussions he had. “You’re supposed to be tough in this game — everyone carries that attitude.”

And there it is.

This is what now gives many parents pause about letting their kids play football — or any contact sport.

Parents are assured that concussion awareness is high in youth sports now, and that coaches won’t put a child with a possible concussion back in the game.

But toughing it out remains part of the ethos of competitive sports. And some coaches still are sending kids back onto the playing field after the kids have sustained hits to the head.

This isn’t a minor matter. Multiple concussions may lead later in life to cognitive impairment, depression and dementia.

Children are particularly vulnerable to concussions, says Jon Bentz, manager of behavioral medicine at Lancaster General Health Physicians Neuropsychology Specialists.

This is why renowned concussion expert and neurosurgeon Robert Cantu says kids shouldn’t play tackle football before age 14.

Same goes for body checking in ice hockey, and heading the ball in soccer.

Too little is known about the long-term consequences of concussion to the developing brain.

So, Bentz recommends, “Hold off as long as you can until that brain has a chance to mature a little bit more.”

And consider other risk factors, he advises.

Those at an elevated risk for concussion include not just children and teens (particularly girls), but athletes with any prior learning disability, a history of headaches, a history of depression or other psychiatric disorder, and those with a propensity toward motion sickness.

It is true that today’s helmets better protect football players against catastrophic outcomes, such as skull fractures and brain bleeds, but they “don’t necessarily reduce the frequency of concussive injury,” Bentz says.

Some new — and pricey — helmets have been shown to reduce concussion risk, but even those have their limits.

And offsetting the improvements in helmet technology is the reality that young athletes today are bigger, faster and stronger, so the force of impact is that much greater, Bentz says.

Coaches of public school sports (including cheerleading) are required by Pennsylvania’s Safety in Youth Sports Act to annually undergo concussion management training.

That law, signed into law in 2011, sets out specific protocols for when an athlete should be removed from play, and when he may return.

But it doesn’t extend to rec leagues and club teams, for which many young athletes are playing these days, often year-round.

The Eastern Pennsylvania Youth Soccer Association has voluntarily adopted the state protocols.

But we shouldn’t be counting on voluntary adherence to practices we know are essential for the long-term health of our children.

Pennsylvania lawmakers ought to amend the law to include rec leagues and nonscholastic clubs.

And parents need to educate themselves about concussion risks.

They need to insist that contact be limited — no heading the soccer ball at practices, no tackling five days a week. And they need to keep an eye on practices — or, as Bentz suggests, take turns with other parents to attend practices to ensure that concussion safety guidelines are followed.

The essential rule: “When in doubt, sit it out,” Bentz says.

And here’s another thing parents and midget football coaches need to consider: Why not replace tackle football with flag football for players under 14?

The players still would learn skills, while their developing brains would be left unrattled.

New Orleans Saints quarterback Drew Brees has said he won’t let his sons play tackle football until they are teenagers. “I think you can be too young to go out there and strap on a helmet,” he told USA Today.

Putting off organized, tackle football worked for New England Patriots quarterback Tom Brady.

He didn’t start playing until high school.

Source: “Concussions among Young Athletes Should Be a Concern for Parents, Coaches and Lawmakers.” LancasterOnline. N.p., 29 Mar. 2015. Web. 29 Mar. 2015.