Randomized Controlled Trial of a Precision Vestibular Treatment in Adolescents
Dr. Michael Collins and Dr. Anthony Kontos
Each year, nearly 2 million children and adolescents have a sport-related concussion in the U.S. but 57% of them do not receive appropriate clinical care following their injury. These injuries involve a very wide range of symptoms. The investigators have developed a treatment model that classifies the injury based specific symptoms and then tailors the treatment to the specific symptoms of the adolescent. Patients whose SRC involves dizziness, environmental sensitivity, and imbalance- are common (60-65% of concussions), and have worse outcomes and a longer recovery. The investigators have developed and tested a specific treatment (precision vestibular treatment) matched to these specific symptoms.
However, there has not been a well-designed randomized controlled trial (RCT) of the effectiveness of that treatment for adolescents with these symptoms. The aim of this study is to determine using a RCT design the effectiveness of this treatment compared to standard of care (i.e., behavioral management interventions) for reducing recovery time, symptoms, and cognitive impairment in adolescent patients with specific symptoms.
Decosahexaenoid Acid and Presynaptic Mechanisms in Mild Traumatic Brain Injury
Dr. C. Edward Dixon and Dr. Shaun Carlson
University of Pittsburgh
A three-year study to use one of the brain’s fatty acids to improve the functioning of neurons in the brain that have been damaged by multiple mild traumatic brain injuries. This study will determine the effects of Docosahexaenoid Acid (DHA) treatment on specific aspects of the neurotransmission deficits that occur after experimental repetitive mild traumatic brain injury (RMTBI) in rats.
The human brain has 50-100 billion nerve cells or neurons that constantly interact with each other. These neurons ‘carry’ messages through electrochemical processes. Chemicals move in and out of these cells to carry these messages. Repeated mild traumatic brain injury (RMTBI) interferes with this process. Docosahexaenoid Acid (DHA) is one of the human brain’s primary fatty acids, and in rodent TBI research, DHA has been shown to have a potentially beneficial role. DHA is safe, affordable, and readily available. This study will determine the effects of Docosahexaenoid Acid (DHA) treatment on specific aspects of the neurotransmission deficits that occur after experimental repetitive mild traumatic brain injury (RMTBI) in rats.
Use of Brain Diffusion MRI Connectometry to Quantitate Connectome Changes
Dr. Juan Fernandez-Miranda and Dr. Fang-Cheng (Frank) Yeh
Many current programs for retired athletes assume post traumatic disorders are progressive neurodegenerative disorders with no known treatment. Thus, the services the athletes receive focus on reducing symptoms and offering support. Recent brain research indicates that the neurons and nerve fibers that “wire” our brain continually change throughout life. Thus, some researchers and programs believe that focusing on reducing symptoms is inadequate; treatment could potentially “rewire” that patients brain and improve their functioning.
UPMC has the research capacity to assess changes in the network of nerve fibers (white matter) in these athlete’s brains over time. Therefore, this study proposes to use UPMC’s research capacity to objectively track any changes in these athletes’ brain function and structure as a result of the Pure Recovery California treatment program based on the research that nerve fibers and their network continually change throughout life.
Automated Detection and Suppression of Brain Tsunamis
Dr. Pulkit Grover
Carnegie Mellon University
A major challenge with post-concussion diagnosis and treatment is that it is not easy to predict if the injury is getting worse, or if the individual is recovering. The focus is on Cortical Spreading Depolarizations (CSDs), aka Brain Tsunamis. Presence of these waves is a consistent indicator of worsening brain injury and it is now believed that CSDs kill neurons, causing further brain damage. Waves of CSDs spread slowly on the brain surface days, or even weeks, following a concussion, causing further injuries. Unfortunately, spread of these waves has no obvious symptoms visible to the naked eye, and hence are undetectable by patient observation.
The proposed study brings together scientific leaders in engineering, neuroscience, and clinicians in brain injury research at Carnegie Mellon University and the University of Pittsburgh to develop automated noninvasive monitoring and treatment of concussions. The following tasks will be accomplished in the proposed study:
- Develop novel EEG systems that can be utilized for thick African American hair.
- Experimental validation and fine-tuning of automated detection algorithms for reliably detecting waves of CSDs in real-time noninvasively.
- Design techniques to noninvasively suppress CSDs.
Biomarker Panel for Inflammation and Tau in Concussed Athletes
Dr. Ava Puccio and Dr. Jessica Gill
University of Pittsburgh and National Institutes of Health
Society’s concern is growing to determine not only safe ‘return to play’ guidelines, but also objective measures to monitor a ‘tipping point’ of repeated damage in safety to continue to play. Biomarkers have the potential to provide objective measures. Sweat is a potential source of non-invasive biomarker collection. Sweat is a clear, odorless substance that is 99% water and rich with biomarkers from multiple parts of the stress response system and can be measured by a sweat patch, which is a non-occlusive, hypoallergenic collection device.
The aim of the study is to generate pilot data to identify and provide a temporal timeline of biological pathways implicated in concussion, (i.e. tau and inflammatory pathways) using novel sweat patch analyses and correlation to objective symptomology. This will further develop our understanding of the pathophysiologic mechanism underlying progressive neurodegeneration following multiple concussive episodes by examining biomarker results in both isolated mild TBI and repetitive sport concussion.