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Concussed

By Alex Piazza
apiazza@umich.edu

Zack Lystedt squared up and tackled his opponent, but there was no celebration afterward.

Video from the junior high football game shows Zack lying on the field, his hands clutching both sides of his helmet.

An official called a timeout and Zack was sidelined until halftime. The 13-year-old from Washington returned for the third quarter, but later collapsed on the field and was airlifted to a nearby hospital where he underwent emergency surgery.

Doctors removed the left and right side of Zack’s skull to relieve pressure from his injured and swelling brain. Prematurely returning to the game after a traumatic brain injury left Zack in a coma for three months.

It took Zack nine months to speak a word and three years for him to stand again.

Traumatic brain injury caused during sports or recreation sends more than 170,000 kids and teens to the emergency ward each year, according to the U.S. Centers for Disease Control and Prevention. And while many of those kids and teens do not suffer the same fate as Zack, sport concussion is globally recognized as a major public health concern that not only affects youth, but also college and professional athletes, as well as other adults in a wide range of sports.

Researchers at the University at Michigan are working on a number of projects that address traumatic brain injury, with a focus on reducing sport concussion and properly evaluating athletes before they return to play.

Headgear

Shoulder pads, mouth guards and knee braces.

Call them fashion accessories for football players.

But when it comes to protection, there is one piece of equipment that reigns supreme on the gridiron—the helmet.

League officials can penalize players who target their opponent’s head when making a tackle, but because of football’s accelerated pace of play, helmets are the primary preventer of traumatic brain injuries.

Like any product, though, football helmets are not perfect. A U-M researcher is developing a prototype helmet called MITIGATIUM that she believes can better protect today’s athletes from concussion.

As part of the Head Health Challenge III, Ellen Arruda and her colleagues received $250,000 to create a football helmet that would effectively dissipate the energy sustained after hits, and thus reduce brain injury.

“Concussions occur when the brain moves relative to the skull, and that motion can be caused by force (how hard something hits something else) and impulse (how much energy is contained in the impact),” said Arruda, professor of mechanical engineering, biomedical engineering and macromolecular science, whose pilot work was funded by the U-M Injury Center. “Current helmets do a very good job of reducing force, and that’s important in preventing brain injuries and skull fractures, but they don’t do a very good job of mitigating impulse. That’s what our whole design strategy revolves around—mitigating force and dissipating energy. You really have to reduce both to prevent brain injury.”

MITIGATIUM was designed using a composite structure that consists of lightweight elastic and viscoelastic components. The combination of a hard polymer shell and flexible plastic reduce most of the initial force and dissipate energy.

Arruda and her colleagues have until January to perfect their prototype. The National Institute of Standards and Technology (NIST) then will run a series of tests on the MITIGATIUM design to determine if it performs better than current headgear.

MITIGATIUM is one of five innovations being tested by NIST, and the winner will receive a $500,000 prize.

“The winning materials show a great deal of ingenuity in their approaches to energy absorption and have the potential to improve the next generation of protective systems,” said NIST Director Willie E. May when U-M was named one of five finalists.

Neck and neck

Squats, bench press and deadlift.

They are the three pillars of strength training, and they are included in most workout plans for football players.

But when an athlete targets an opponent’s head, those exercises won’t necessarily prevent traumatic brain injury.

James Eckner has studied sport concussion for years, and the assistant professor of physical medicine and rehabilitation now focuses his research on how the neck influences head motion after impact.

Eckner and his U-M colleagues, including Professor James Ashton-Miller, conducted an 8-week exercise intervention that was designed to strengthen the neck muscles of male and female youth athletes who compete in contact sports. Researchers sought to determine the effect of the neck strengthening program on athletes’ neck size and strength, as well as how their heads move when small standardized test forces were applied to their heads in a lab setting.

Participants performed a number of exercises designed to strengthen their neck muscles over 8 weeks, and researchers found that with greater neck strength, the magnitude of head acceleration following impact decreased.

“This is very interesting to me because this means that neck strengthening interventions hold promise as a potential way to reduce an athlete’s concussion risk,” said Eckner, whose pilot work was funded by the U-M Injury Center.

And while neck exercises could help prevent concussions, Eckner, Ashton-Miller and their U-M colleagues also developed a tool that can assist with quickly identifying concussions after they occur.

Slowed reaction time is both a risk factor and a consequence of sport concussion. But many teams rely on expensive computer programs to measure an athlete’s reaction time when assessing them for a concussion.

That’s why U-M researchers developed a simple, inexpensive, manual neurological testing device that measures reaction time.

Here’s how it works:

A tester vertically holds the standardized device, and when it is dropped, the athlete catches it as quickly as possible.

The distance it fell is then converted into a reaction time using the formula for a body falling under the influence of gravity. Researchers found the average reaction time measured over eight drops with this simple test could identify athletes with concussion just as well as other longer, more expensive computerized concussion tests.

The research team now is beginning to study a more complex version of the reaction time test that uses lights attached to the device to force an athlete to quickly decide whether to allow it to fall, or catch it before it hits the ground. Their goal is to determine whether the forced decision improves the test’s ability to detect concussions.

Preseason routine

College football season is just weeks away, and student-athletes across the country are studying their playbook and watching game film to gain a competitive advantage.

And for 30 schools, from Los Angeles to Miami, preseason preparation also means a comprehensive concussion evaluation led by U-M researcher Steven Broglio and his colleagues across the country. Concussions remain a serious concern within college athletics, as student-athletes suffered an average of 10,500 concussions for the past five years, 3,400 of which occurred in football.

In an effort to enhance player safety, for the past three years, Broglio has led the most comprehensive study of concussion and head impact exposure ever conducted.

As part of the NCAA-Department of Defense Concussion Assessment, Research and Education (CARE) Consortium study, every student-athlete from 30 schools nationwide, including U-M, undergo baseline testing before the season begins. Then, data are collected at specific intervals if he or she suffers a concussion so researchers can study the natural history of their traumatic brain injury.

So far, Broglio and his colleagues have collected more than 35 million data points from 18,000 student-athletes at 21 institutions. Nine schools recently joined the $23 million study, which should increase the number of participants to 25,000 this year.

“To date, we have already studied over 1,000 concussions,” said Broglio, associate professor of kinesiology. “An average concussion study includes about 20 concussions, so you can see how expansive this study actually is.”

The goal is to improve athlete health and safety surrounding concussion, as well as the behavior and culture of concussion reporting and management.

“NCAA schools have placed a priority on improved concussion management, but we still have many unanswered questions in this area,” said NCAA President Mark Emmert when the consortium was announced. “We believe in the incredible potential of this research. Student-athletes will be first to benefit from this effort, but it also will help to more accurately diagnose, treat and prevent concussions among service men and women, youth sports participants and the broader public.

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