Insider's Look: Concussion Care and Research

Dr. Christina Master: [00:00:09] About two and a half million kids every year sustain concussions, and we think that probably it’s an underestimate.

Dr. Kristy Arbogast: [00:00:15] About 20 percent of teenagers have had at least one concussion. Only about two-thirds of those concussions are due to sports.

Dr. Kristy Arbogast: [00:00:23] I’m Kristy Arbogast. I’m a biomechanical engineer and I am co-lead of the Minds Matter Concussion Program.

Dr. Christina Master: [00:00:30] And I’m Tina Master. I’m a pediatric sports medicine specialist and I’m the other co-lead of the Minds Matter Concussion Program. We like to think of it as a comprehensive program where we are trying to do our very best to diagnose, treat, but also advance our understanding of how to better diagnose and treat children with a concussion through research.

Dr. Kristy Arbogast: [00:00:55] I think you’re seeing a culture and an environment where a teammate is looking out for their teammate, if they see they’ve had a big hit. And making sure that they are getting medical attention. The sooner you get to medical attention, the better your outcomes are.

Dr. Kristy Arbogast: [00:01:13] Another very important issue that we have been focused on is trying to understand repetitive head impacts. We’ve started a research program studying soccer heading in adolescents, and we’re trying to understand how a series of soccer headers affects the function of the brain. We think we have an opportunity to understand how to reduce the number of times a child may impact their head or the severity that they may impact their head with.

Dr. Kristy Arbogast: [00:01:42] So one of the ways we’re learning about the biomechanics, or the engineering, of concussion is through instrumented mouth guards. So these are regular guards, but in it is embedded electronics. And what that electronics tells us is how fast their head is moving, and in what direction. That allows us to understand what might be going on in the brain. We can use computer models to look inside the brain, to tell us if the head moves in this way, the neurons of the brain stretch, the blood vessels of the brain stretch, in this particular way that might end up causing damage.

Dr. Kristy Arbogast: [00:02:19] This technology is very similar to what’s being implemented right now in the NFL. I served as a consultant for the NFL and the NFL Players Association to help them understand the scenarios in which concussions happen in professional football. Two and a half million kids sustain a concussion every year- 30 percent going on to long-term challenges. That’s a big number and we really have an opportunity to impact a large number of children, a large number of families.

Dr. Christina Master: [00:02:50] Concussion can really effect just their general mental well-being. Anxiety and depression are very real effects of concussion that we have to be aware of. So another instrument that we’re really excited about is the pupillometer. It is a device that is handheld and portable and potentially could have real relevant clinical utility on the sideline, in the athletic training room, besides in the office where we are currently examining it.

Dr. Christina Master: [00:03:14] What the pupillometer does is it shines a light at your eye, and then it uses an infrared camera to capture how your pupil responds to that light. And so you’re actually able to get very precise measurements in terms of how quickly your pupil responds to light. And that seems to be changed after concussion. And so we just had a research publication that came out last year in JAMA Ophthalmology that indicated that this device has a lot of promise.

Dr. Christina Master: [00:03:40] We’re hopefully moving the diagnosis of concussion from, “Hey, how you feeling? Do you think you have a concussion?” And reporting symptoms of headache and dizziness and feeling off balance, to hopefully objective measures that we’ll be able to use both in diagnosis, as well as monitoring, and then a safe return to play after recovery. So we’re very excited about these technologies.

Dr. Christina Master: [00:04:07] A lot of us grew up thinking that when you have a concussion, it’s no big deal. That you’ll be better in a few days and there’s nothing to really worry about. There’s probably up to a third of kids where they can have really debilitating issues with headache, dizziness, balance issues, sleep issues, emotional issues, that can last for weeks and sometimes even months.

Dr. Kristy Arbogast: [00:04:25] We have the largest concussion patient volume in the country, and that really enhances our ability to understand this issue very fundamentally.

Dr. Christina Master: [00:04:35] Kids can take up to four weeks or longer to recover from a concussion and 30 percent of them can take longer. If we take an active approach to recovery, they seem to do much better. We have both sports medicine doctors, as well as ER doctors, nurse practitioners, nurses, and athletic trainers who help us. We also have biomedical engineers and epidemiologists and statisticians. And so that makes for a really rich conversation about how we can best move forward concussion care for children.

Dr. Christina Master: [00:05:06] The people who are involved and who have the chance to be involved with us, they really understand the impact of concussion on a child’s life. We’ve been very successful in getting NIH and CDC and DOD and NCAA funding, but we do find that philanthropy allows us to ask questions that maybe those traditional funders find a little bit risky, but we’re asking those questions because those are the questions that our patients are asking, and our families are asking us. What is great about working with our donors is that our agenda is their agenda. What they would like to accomplish very much resonates with us and so it’s been a huge support to us. We’ve been really thankful for it and excited to partner with new partners for the future.