Dr. Bara Alsalaheen is the associate director of research and associate professor of Physical Therapy at the University of Michigan-Flint and is a research assistant professor of Neurology at U-M Medical School. He is also a Michigan Concussion Center faculty member. Dr. Alsalaheen serves as a physical therapist at Michigan NeuroSport. His clinical and research interests include sports-related concussions, and neck and spine injuries.
We sat down with Dr. Alsalaheen to learn more about his concussion interests, his research, and why he is excited to be a part of the Michigan Concussion Center.
Dr. Bara Alsalaheen poses in front of the physical therapy clinic at Domino’s Farms in Ann Arbor, MI.
How did you become interested in working with concussions?
It started during my time at the University of Pittsburgh, where I earned my PhD in Rehabilitation Sciences. One of many reasons for my curiosity about concussions is my fascination with the human brain and its ability to adapt after injury and throughout rehabilitation. I became interested in working with concussed patients because no two are alike. It is rewarding from a clinical standpoint, especially when you embrace an interdisciplinary management model that transcends professional boundaries, like our approach here at Michigan Medicine.
What are some of the Physical Therapy treatments for patients with a concussion?
Concussion patients present to PT with various symptoms that require targeted PT interventions. They include headache, dizziness, neck pain, balance problems, and many other symptoms. Depending on the symptoms reported by the patient, a physical therapist conducts a detailed exam and provides the appropriate intervention. These interventions can include vestibular rehabilitation exercises to treat dizziness, exercises and manual therapy for neck pain and cervicogenic headache, balance and functional mobility exercises, and exertional exercises to address deconditioning and monitor re-emergence of symptoms. The goal of all these various interventions is to prepare patients for a seamless and full return to function including the return to school, work, sport, or military duty.
What are your specific research interests in concussion rehabilitation?
My interests in concussion rehabilitation are directed toward finding the right treatment(s), for the right person, at the right time. To achieve that, I am interested in 3 areas.
The first area is optimizing clinical assessment and treatment of patients with multiple impairment domains. Currently, concussion patients are generally classified into one of about seven impairment categories and are provided treatment(s) accordingly. For instance, if a patient has dizziness and abnormal eye-head coordination, they will be assigned (i.e. classified) to the vestibular category and receive vestibular rehabilitation. We have found that more than 50% of patients with concussion do not perfectly fit into a single category. Instead, they have impairments from multiple categories (i.e. overlapping impairments). When we think about these seven subtypes and how many different combinations you could have, we realize that each patient is unique and requires a more targeted treatment that recognizes the complexity of their presentation without the need to classify them into one specific bucket. My research interest in this area is to develop and validate a model to guide rehabilitation clinicians to identify and prioritize assessment and treatment choices in patients with overlapping impairments. The goal of this model is to optimize the recovery of patients with concussion by treating the impairment that is causing most of their burden, and then going to the next one until all impairment domains are resolved and the patient is fully recovered. This approach emphasizes the focus on the person as a whole as opposed to a specific impairment domain.
My second area of interest is to identify the ideal timing to begin concussion rehabilitation. Currently, unwarranted variations in the timing to initiate concussion rehabilitation exist. This unwarranted variation is associated with suboptimal clinical outcomes and improper utilization of healthcare resources. My research is evaluating the optimal timing to initiate post-concussion rehabilitation and its effects on various clinical and health-system outcomes.
My third area of interest related to concussion is in implementation science. Today, more than ever, there is a gap between concussion knowledge and clinical practice. This knowledge-to-practice gap impedes recovery outcomes and contributes to unwarranted variations in concussion care. My research in this area is beginning to examine how to improve the uptake of concussion evidence in clinical practice and the outcomes of implementation on outcomes at the patient, clinician, and organizational level.
What other areas are you interested in?
I’m interested in developing good outcome measures related to various concussion-relevant domains. Many clinical measures currently used in patients with concussion were mainly developed for middle-to-older aged adults with other conditions. Therefore, the ability to capture post-concussion impairments in a younger and healthier population is limited. Some of my work involves developing and validating measurements that can capture subtle deficits in otherwise healthy concussion patients.
Another area of my research is related to the role of neck muscle characteristics in concussion prevention and whether targeted training programs can improve head stability and reduce concussion risks. I’m working with Dr. James Eckner, who is leading the charge on a large neck strengthening study underway here at U-M, which includes at least five collaborators who are current Concussion Center faculty members.
What is the next frontier of concussion research in your area?
I think the next big frontier is how to leverage big data, patient registries, and learning health systems to answer multi-dimensional concussion questions in a complex healthcare system. This approach will not only be beneficial to patients and clinicians, but it will also inform policy and system decisions. A powerful example of this frontier is the CARE Consortium and how it exponentially expanded our knowledge related to concussion diagnosis and natural history of concussion in college athletes and military cadets. The next frontier is to implement a similar systematic approach to study concussion treatment and rehabilitation outcomes across the lifespan in a realistic healthcare environment.
How could this partnership with the Concussion Center help your research?
It will provide me with an environment to facilitate access to a vast network of interdisciplinary collaborators that are organically integrated into clinical environments. This clinician-scientist collaborative model maximizes the impact of our research on improving health outcomes. The outreach and engagement core of the center will leverage the impact of our research by translating it to various stakeholders to impact education and policy.
What makes you excited to be a part of the Concussion Center?
What excites me the most is the vision. The Concussion Center actualized the ideal environment I always believed we are poised to have at the University of Michigan. I am fortunate that the collective efforts of my colleagues brought this to fruition much sooner. Before the center was established, I had the privilege to work with many talented researchers and clinicians doing great concussion work at U-M. However, there wasn’t a central hub that allowed us to leverage our collective expertise and maximize the impact of our research and clinical work. The collective impact of the center will be much greater than the sum of its parts. A key element to that is the harmonized interactions between research, clinical practice, and education and outreach efforts.