Navigating the Concussion Frontier by Brian Hainline

PowerPoint Presentation

NAVIGATING THE CONCUSSION FRONTIERBrian Hainline, MDNCAA Chief Medical OfficerClinical Professor of NeurologyIndiana University School of MedicineNew York University School of Medicine

Sport Science InstituteMission: To promote and develop safety, excellence, and wellness in college student-athletes, and to foster life-long physical and mental development.

Sport Science InstituteVision: To be the pre-eminent sport science voice for all student-athletes and NCAA member institutions, and to be the steward of best practices for youth and intercollegiate sports.

Strategic AgendaPhase I:Trust.Identify Knowledge Gaps.Phase II:Education.Eptitude.Phase III:The NCAA is recognized as the leading Public Health authority in the sports world.

Knowledge GapsConcussion.Mental health.Cardiac health.Overuse & early specialization.Doping & recreational drug use.Data analytics & informatics.Sexual Assault and Interpersonal ViolenceNutrition and Performance

CSMAS identified us as collaborator5

Concussion

ConcussionOf the 43 working definitions of concussion, 1 is evidence-based and none localize brain dysfunction.We do not understand the natural history of concussion.We do not understand neurobiological recovery in concussion.

43rd Working Definition of ConcussionConcussion is:a change in brain function,following a force to the head, whichmay be accompanied by temporary loss of consciousness, but isidentified in awake individuals, withmeasures of neurologic and cognitive dysfunction.

NCAA and DoD Joint Endeavor>97% of military TBIs are concussions.85% of military concussions are biomechanically similar to sport-related concussion.15% are from blast injuries.College s-a and military service are similar in age, athleticism, risk taking and pushing to the edge of excellence.The military theatre is poorly controlled; college sports are a much more controlled environment.Numerous meetings, evaluations, culminating in NCAA-DoD MOU and CRADA and White House announcement.

Negotiate 8 contracts and 22 sub-contractsSubmit 24 IRB and HRPO applications

Convene 2 investigator meetings

Develop CSC, ARC, and AOC protocols and conduct training

Develop SOPs Launch Website(www.careconsortium.net)

Build CARE Electronic Data Capture System and Direct Entry Portal

13,241 baseline evaluations completed among athletes/Service Academy cadets; Collected 176+ specimens; Injury data on 310 concussionsAward received Sept 2014

September2015

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Clinical Study AimsClinical Study Core (CSC)To conduct a prospective, longitudinal, multi-center, multi-sport investigation that delineates the natural history of concussion in both men and women by incorporating a multi-dimensional assessment of standardized clinical measures of post-concussive symptomatology, performance-based testing (cognitive function, postural stability), and psychological health.Advanced Research Core (ARC)Utilize the framework of the CSC to conduct advanced scientific studies which integrate biomechanical, clinical, neuroimaging, neurobiological and genetic markers of injury to advance our understanding of neurophysiological effects and recovery after sport-related concussion in college student-athletes.

Assessment Categories

Assessment Measures: ARCHead Impact SensorsHead Impact Telemetry (HIT) System and X-PatchNeuroimaging Studies (3T MRI)T1 SPGR anatomical images.T2 FLAIR for general pathological detection.Diffusion weighted MRI (DTI and DKI) for microscopic white and gray matter injury.SWI to identify microhemorrhage.Pseudo-continuous arterial spin labeling (pCASL) for cerebral blood flow.GenotypingAPOE, GDNF, COMT, etcBlood Biomarker StudiesAcute BiomarkersUCH-L1 (ubiquitin C-terminal hydrolase L1; neuronal protein).GFAP (glial fibrillary acid protein; astrocytic protein).SBDP150 (calpain cleaved fragment of alpha II-spectrin breakdown product 150; a neural cell cytoskeleton structural protein).S100B (S100 calcium binding protein B; astrocytic protein).Micro RNAChronic BiomarkersMAP-2 (microtubule associated protein-2; marker of axonal damage).CNPase (2,3-cyclic-nucleotide 3-phosphodiesterase; marker of oligodendrocytes).Micro RNA

Executive CommitteeHainline (NCAA), Hack & Rauch (DoD), Koroshetz (NIH)Administrative Coordinating Center:Indiana U School of MedicineMcAllister (coPI) Advanced Research Coordinating Center:Medical College of WisconsinMcCrea (coPI)Longitudinal Clinical Study Coordinating Center:U of MichiganBroglio (coPI)Longitudinal Clinical Study Core (CSC)Advanced Research Core (ARC)U Nebraska(BIG10)MolfeseU Michigan(BIG10)EcknerWashington(PAC12)ChrismanU North Carolina(ACC)Guskiewicz & MihalikU Pittsburgh(ACC)Kontos & CollinsU Georgia(SEC)SchmidtU Florida(SEC)ClugstonU Oklahoma(BIG12)AndersonUCLA(PAC12)Giza & DiFioriConsortium Operating Committee

Anderson, Broglio (co-Chair), Clugston, Duma, Giza, Guskiewicz, McAllister (co-Chair), McCrea (co-Chair), McGinty, Molfese, PutukianSenior Scientific Advisory PanelIverson, Jordan, Kelly, Marshall, Saykin, Smith, Talavage, Wallace, XuU Wisconsin(BIG10)BrooksPrinceton(Ivy)PutukianConcussion Research Initiative US Military Academy(Independent) Svoboda & KellyUS Air Force Academy(Mountain West)McGinty & CampbellUS Coast Guard Academy(New England)DoriaUS Naval Academy(Independent)Pyne & TsaoVirginia Tech(ACC)Duma & RowsonU Delaware(Colonial)Buckley & KaminskiHumboldt State(California Collegiate)OrtegaAzusa Pacific(Pacific West)HoyU Rochester(University)BazarianCal Lutheran(Southern California)DavisTBDYear 3TBDYear 3TBDYear 3TBDYear 3TBDYear 3TBDYear 3TBDYear 3TBDYear 3TBDYear 3

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CSC & ARC Assessment Protocol

Pre-SeasonAcute ConcussionSub-Acute ConcussionPost-ConcussionBaseline