Faculty Profile: Jingwen Hu

Jingwen Hu is the associate director of the University of Michigan Transportation Research Institute (UMTRI) and a research associate professor in UMTRI and the Department of Mechanical Engineering. His research primarily focuses on using a combination of experimental, computational, and epidemiological procedures to study impact/injury biomechanics and injury prevention.

Dr. Hu has recently developed parametric computational human models representing diverse populations. Such models have been used to study the injury mechanism and safety design optimizations for motor vehicle crashes in various vulnerable populations, such as children, the elderly, obese occupants, pedestrians, pregnant people, and wheelchair users.

We sat down with Dr. Hu to speak about his research and how his parametric computational human model can help advance concussion science.Jingwen Hu

Michigan Concussion Center: Can you talk about your career path and research?

Dr. Jingwen Hu: My undergraduate degree is in automotive engineering and I have always been fascinated by vehicle crash tests. Albert King, a professor of biomedical engineering at Wayne State University, inspired me to go into impact biomechanics by his quote, “vehicles are designed for humans, not dummies.” I was thinking if you don’t know the human being and how they get injured, you cannot design a better car. That is why I pursued my PhD in Biomedical Engineering focusing on impact biomechanics.

My main research area uses computational human body models to do injury assessment and design safety countermeasures for injury prevention. Human models are universal tools that can apply to injury prevention or safety design not only in motor vehicle crashes but also in sports and many other injurious events. Additionally, I am also a big sports fan and concussions are something I am passionate about. I believe that the parametric human modeling concept we used for vehicle crashes can directly apply to concussion assessment and prevention.

MCC: What is the parametric finite element human model?

JH: A finite element human model separates the body into thousands or even millions of small elements, where we assign different material properties to represent different body tissues. The model can predict the tissue biomechanical responses of the human body, including the brain, under various impact conditions. The assumption is that the model’s tissue responses, such as strain and stress, will correlate better to injury than head kinematic measures from video footage or sensors since they do not measure tissue-level deformations.

At the same time, there are large variations in skull and brain geometries in the population. The geometry variation will highly affect the tissue-level responses in the brain. That is why we cannot use one human body model to represent everyone. The parametric human model can account for the morphological and biomechanical variations among the population, which should give a much better prediction at the tissue level of a future concussion.

MCC: How does this compare to other models?

JH: One of the main difficulties in injury assessment and prevention is human diversity because the current safety designs are primarily based on one dummy or a single computational human model representing a mid-sized male. Finite element human models are time-consuming to build, which could take upwards of a year to build a single model. Therefore, it is almost infeasible to develop many different human models to represent a diverse population using the traditional approach.

Our parametric modeling approach uses automated mesh morphing tools to change the geometry of one human model to another person so we can represent a diverse population. We use medical image and body scan data and quantify 3-D geometry variations of a skeleton, internal organs, and external body surface among the population. This way, we can tell predict the human geometry based on age, sex, stature, weight, or other physical measures of a person and quickly morph a baseline human model into the predicted geometry. In the future, we could then develop many models for different athletes, and potentially predict the injury risk in their brains more accurately.

I believe that our approach is a paradigm change. Instead of using a single model, we can generate hundreds or thousands of human models for population-based simulations. Now that we have this capability, we could run the model millions of times under different impact conditions and use some machine-learning models to predict the strain/stress distribution in the brain of an athlete in a specific impact condition. Those will be instantly useful results and a future tool to help us put the subject-specific injury assessments into safety design. We could even evaluate specific impact distributions for certain types of athletes and begin designing specific safety features to best protect them.

MCC: How do you gather the subject’s geometric information?

JH: We have a partnership with the U-M Medical School and the Department of Radiology, where we receive thousands of CT scans from them. When we get the images, we use 3-D reconstruction software to extract the geometry of the skin and the skull’s outer and inner surfaces. We then use the statistical analysis to quantify the variations in those 3-D geometries and predict the geometry based on a given set of subject covariates.

MCC: How do you hope your model will move concussion science forward?

JH: I think this will be a good tool for both injury assessment and injury prevention. Current diagnosis procedures for concussion are largely based on a patient’s self-reporting, which is somewhat subjective and does not consider the biomechanical responses inside of the brain. We think this model could potentially be used as an objective tool to quantify the severity of a concussive impact.

Let’s say in the future we have some on-field sensors to quantify head impact accelerations. We could take that information along with the subject co-variates to quickly predict the strain and stress distribution in the brain. If we see some high strain areas that are over the threshold, we can say this impact is on the high alert. Even though the player may not behave out of the ordinary, we can be more cautious and further evaluate them. So this is a tool that can provide objective evaluation beyond those based on our current technology and procedure.

The other thing I’m thinking is that the model can help design safety equipment. Let’s take the helmet as an example. Currently, college ice hockey players and football players only have a few sizes that they can pick, and they may not necessarily fit an athlete well. We could fix that by creating a subject-specific design feature to fill in the gap and make sure that helmets fit better and are more comfortable. Furthermore, personalized design features can be tailored to better prevent brain injuries based on model prediction.

We can also use this model to run simulations to test hypotheses. For example, there are differences between male and female concussion rates, but we don’t know why. One potential reason could be neck strength. We could use the computational model to have different neck muscle models and then run the impact simulation to see the concussion risk. The data from the computational simulations could help fill in where we don’t have data.

MCC: What are the next-level barriers of concussion research in your area of expertise?

JH: One of the biggest hurdles is going to be figuring out how we can validate this model. We want to make sure we have a biofidelic model to make sense of its results, which requires field data. We can measure some of the head kinetics with sensors attached to the helmet, skin, or mouthguard. We need to gather this kind of information to check whether model-predicted responses can be correlated with a concussion. We will need to collect large data sets to say if this model indeed improved concussion prediction and be used as a reliable way to provide critical injury risk assessment.

MCC: What excites you most about being a member of the U-M Concussion Center?

JH: I’m an engineer by training, so my vision is focused on the engineering part of this multi-disciplinary problem. However, getting to know so many medical doctors and understanding their perspectives on concussions makes my vision and contribution to the theme of concussion prevention much broader. This is extremely valuable for me.

Center faculty members study the effect of dynamic supervised exercise challenges on concussion recovery

Research continues to show the benefits of incorporating supervised exercise during the early symptomatic period following a sport-related concussion.

Jeremiah Freeman, a certified athletic trainer with Michigan NeuroSport, worked alongside Dr. Michael Popvich, clinical assistant professor of Neurology at the University of Michigan, on a study looking to determine how well the introduction of dynamic supervised exercise challenges can guide in-clinic management decisions to help an athlete recover quicker. Jeremiah Freeman

Under standard clinical care, physicians and athletic trainers establish strict exercise parameters when first seeing a patient in the clinic following a concussion. Dynamic supervised exercises are clinically-supervised controlled movements and exercises designed to challenge a patient by inducing symptoms not normally present during supervised aerobic exercises. This way, a clinician can establish how the patient is progressing.

“We’re trying to exacerbate symptoms because we want to find the exercise points that we don’t want them hitting on their own. We’re addressing movements and things that will challenge their head in ways that give them symptoms in a supervised, controlled manner,” Freeman said. “This is what helps progress them.”

Freeman starts patients on a stationary exercise bike because it presents the least amount of stimulation. From there, the patient progresses to either an elliptical machine or jogging on their own to induce head motion and background stimulation. If the patient doesn’t show any symptoms, they begin running on a treadmill.

After the cardio exercises, the patient progresses to balance and spatial awareness exercises to work on their vestibular function. Freeman said that the head motion and eye movement associated with these exercises typically cause the patient to report symptoms.

“While you will feel symptoms while doing these head exercises, these help you get better and make it so you can check your blind spot while driving and not get dizzy or catch a pass or punt,” he added.

Finally, the patient progresses through agility exercises (quick stop and starts, change of direction, etc.) and sport-specific exercises before being fully cleared to return to play.

A zero to 10 scale (10 being the worst and 0 meaning no symptoms) is used to determine a symptom’s severity during exercise. A three-point increase on the scale determines when a patient needs to take a rest. If the symptom remains at a three-point increase following the rest period, the patient is told to stop.

The study’s outcome showed that adding in dynamic exercise challenges were safe and didn’t worsen a patient’s recovery. Patients who initiated the supervised exercise while still symptomatic returned to their sport earlier than those who waited until they were symptom-free to start exercising.

“We increase the intensity as they go along, and so this kind of knowledge, that helping them exercise more gets them better faster, encourages us as practitioners to push them,” Freeman explained. “We know what the limits are; we know what is good for them as long as we keep it within certain parameters. It helps us guide their treatment.”

Freeman added that further research into this area could help determine which exercises help patients recover faster from a concussion.

Center welcomes Dr. John Leddy for Speaker Series talk

Dr. John Leddy, clinical professor in the Department of Orthopaedics at the University of Buffalo Jacob School of Medicine & Biomedical Sciences, joined the U-M Concussion Center on Thursday, October 28 for the first in-person Speaker Series event since the series started.  Over 100 guests were also able to join the hybrid session to hear Dr. Leddy’s remarks.

John Leddy

His talk, entitled “Concussion: Physiology Informs Treatment,” described aspects of the physiology of concussion with respect to the autonomic nervous system and cerebral blood flow regulation, the role of exercise tolerance testing in the prescription of individualized sub-threshold aerobic exercise for the treatment of concussion and persistent post-concussive symptoms (PPCS), and how the principle of “exercise intolerance” is used in the treatment of concussion.

The presentation was held in the School of Kinesiology Building’s new distance-learning classroom. 

You can view the entire presentation at concussion.umich.edu/resources/.

Dr. Doug Smith will present on Thursday, January 27, 2022. He is the director of the University of Pennsylvania Center for Brain Injury and Repair as well as the Robert A. Groff Endowed Professor and vice-chairman of Neurosurgery at the University of Pennsylvania.

MICHR hosts research jam

Faculty members from over a dozen units from across the University of Michigan campus came together on Tuesday, October 12 for a discussion focusing on identifying strategic enablers of the center’s concussion-related research. 

People standing in semi-circle listening to speaker

The session was facilitated by the Michigan Institute for Clinical & Health Research with collaboration from the University of Michigan Office of Research. 

J.T. Eckner, associate director of research for the center, was pleased with how the event turned out. “It was nice to get validation of things the group thought were important as well as fresh ideas that weren’t thought of before,” he said. 

Carrie Morton, deputy director for the center, was thrilled to partner with such a valuable campus resource like MICHR to facilitate a dialogue among colleagues.  “The outcome of the Jam will help the center to be strategic in our investments, making sure to have the most positive impact possible for our faculty.”

Center hosts concussion and long-term neurological health panel discussion

The U-M Concussion Center hosted the virtual discussion “Concussion and long-term neurological health: Have we just scratched the surface?” on Thursday, October 21.

Raquel Gardner, associate professor of Neurology for the University of California, San Francisco School of Medicine’s Welli Institute for Neurosciences; Thomas McAllister, Albert Eugene Sterne Professor of Clinical Psychiatry at Indiana University School of Medicine; and William Meehan, associate professor of Pediatrics and Orthopedics at Harvard Medical School and the director of the Micheli Center for Sports Injury Prevention at Boston Children’s Hospital were the featured panelists. They joined Center Director Steve Broglio, who moderated the panel, to discuss the current science around concussions and long-term neurological health, including what is known and what still needs to be learned. 

“The Concussion Center was excited to host a nuanced discussion on long-term neurological health following concussion and head impact exposure. Dr’s. Garner, Meehan, and McAllister are immersed in both clinical care and research, giving them unique perspectives on outcomes among athletes and non-athletes across the lifespan,” Broglio said. “While it is clear there is much more to be learned, our understanding is far more advanced than it was even 4 or 5 years ago.”

The panel discussion is posted online at concussion.umich.edu/resources/.

Broglio talks concussion with The Michigan Daily

Dr. Steve Broglio, professor of Athletic Training at the U-M School of Kinesiology and director of the U-M Concussion Center, spoke with The Michigan Daily about the new findings regardingDr. Steve Broglio the new timeline for concussion recovery and about the $42.65M grant the CARE Consortium received.

A total of 1,751 concussion cases were included in the study, with results showing 85% of people took over one month to be cleared for unrestricted participation in sports after a concussion.

“We need to reframe the normal recovery time because there’s variability in how people recover from all injuries,” Broglio said.

A main goal of the study was to normalize longer recovery rates, according to Broglio. Broglio said if sports teams follow the current medical literature, anyone who has 14 or more days of recovery time is “bucketed into the abnormal recovery group, even though they’re a 51st-percentile person.”

The “abnormal” label given to athletes can be mentally demanding, Broglio said, and can often cause them to put their athletic career before their physical health. Broglio said he has heard of many injuries ignored or not reported until after an event.

“A concussion is unique in that if an athlete wants to hide it, it can be hidden,” Broglio said. “From a psychological standpoint, we’re trying to reduce inadvertent pressure on teammates, coaches, and parents to get somebody back to play by reframing this from a more holistic manner.”

Read the full article here.

NCAA-DOD CARE Consortium receives $42.65M award to launch the next phase of study co-led by U-M

Next phase of CARE, the CARE-SALTOS Integrated (CSI) Study to follow athletes 10+ years after concussive injury and repetitive head impact exposure

The NCAA-U.S. Department of Defense Concussion Assessment, Research and Education (CARE) Consortium — the largest concussion and repetitive head impact study in history — has received a $42.65 million award to launch the next phase of the landmark research project that is co-led by the University of Michigan.

The U.S. Army Medical Research and Development Command (USAMRDC) awarded $25 million to CARE, with an additional $10 million coming from the NCAA and $7.65 million from the Defense Health Agency.CARE Consortium Logo

CARE is the product of the historic NCAA-DOD in 2014, and the next phase, known as CARE/Service Academy Longitudinal mTBI Outcomes Study (SALTOS) Integrated (CSI) Study, will investigate the long-term effects of head impact exposure (HIE) and concussion/mild traumatic brain injury in NCAA student-athletes and military service members.

The University of Michigan leads the longitudinal clinical study core, a prospective, multi-institution clinical research protocol. Dr. Steven Broglio, professor of kinesiology and director of the U-M Concussion Center at Michigan, is a co-PI of the CSI award.  U-M is joined by Indiana University School of Medicine, the Medical College of Wisconsin, and the Uniformed Services University of the Health Sciences as core leaders along with over 30 other institutions.

“The University of Michigan has played a crucial role in the initial phases of the CARE Consortium by addressing previously unanswered questions on the natural history of concussion across a diverse set of athletes and military service members.  The current funding will allow us to begin rigorous inquiry of the long term effects of concussion in those same athletes and service members,” said Broglio.

The initial phase of CARE focused on the six-month natural history and neurobiology of acute concussion and HIE. The second phase, CARE 2.0, prospectively investigated the intermediate effects — such as changes in brain health outcomes over a college career — and early persistent health effects associated with HIE and concussion soon after graduation. The latest awards bring the total Grand Alliance funding now to over $105 million.

The CSI investigative team will build upon existing CARE/SALTOS research by following former CARE research participants beyond graduation to evaluate the long-term or late effects of HIE and/or concussion/mTBI for up to 10 years or more after initial exposure or injury.

“Identifying the neurobiological pathways that possibly contribute to long-term negative consequences of concussion and repetitive head impacts is critical for the development of early interventions and strategies in athletes and service academies who are at risk,” said NCAA Chief Medical Officer Dr. Brian Hainline. “We are confident this award from MTEC, coupled with additional funding from the NCAA and DOD, will provide us the support to develop an array of interventions that mitigate possible long-term effects of concussion or HIE.”

The most comprehensive, prospective study of its kind to better understand concussion, HIE and effects on brain health, the CARE Consortium is funded by the NCAA and U.S. Department of Defense with broad aims to enhance the health and safety of NCAA student-athletes and military service members. It also serves as a valuable resource for youth sports participants and society at large. It is also the first major concussion study to assess both women and men in 24 sports; prior to CARE, most concussion literature came from men’s football and men’s ice hockey.

The CARE Consortium is overseen by principal investigators at research institutions across the country. Leveraging its extensive infrastructure and experienced research team, CARE has published over 80 scientific papers that are critical to advancing the science of mTBI/concussion and HIE.

With the MTEC/DOD award, combined with additional funding from the NCAA, CSI is now well-positioned to investigate the brain health of NCAA athletes and military service members who have had concussion or HIE, compared to those who have had neither. Additionally, the effects of other medical conditions on brain health will be assessed in military service members.

An integrated public/private effort, CSI is designed to identify the unique individual characteristics (such as phenotypes/genotypes) of individuals at a higher versus lower risk of negative outcomes associated with concussion and HIE. This dataset will be made available to the broader scientific community to promote further development of specific strategies for injury prevention, early recognition, and mitigating treatments of those at greatest risk of brain health effects.

U-M Concussion Center teams with Detroit Public Schools Community District to develop student-athlete concussion toolkit

The University of Michigan Concussion Center and Detroit Public Schools Community District have partnered to develop a concussion toolkit to improve concussion prevention, identification, and care for student-athletes.

Two DPSCD student-athletes playing basketball this past season. Photo courtesy of Robert Allen McClain, studentandathlete.com

The toolkit addresses gaps in concussion education, lists available resources and provides information about follow-up care, and was the product of workshops with leadership from both organizations and coaches, staff and parents. It contains educational and procedural information on how to handle a suspected concussion and information on concussion care, management and treatment options. The Michigan High School Athletic Association also contributed expertise.

The toolkit was introduced to coaches and administrators during the DPSCD Athletic Symposium in August.

Friday, Sept.17, is National Concussion Awareness Day.

The district’s responsibility is to keep athletes as safe as possible, said DPSCD program supervisor Anika McEvans, who hopes to share the toolkit and lessons learned with other districts.

“With an incident like concussion, it’s important that we get it right and provide as much information as we possibly can,” she said. “For a parent who doesn’t deal with this on a regular basis, the ease of use and formatting that comes out of this is probably the most valuable thing.

“Very often, we get caught up in the work that we do for our district, but we discovered that this work could transition outside of our community into school districts all across the state.”

Carrie Morton, deputy director of the U-M Concussion Center, says “athletics is such an important part of the youth experience, and being able to work with DPSCD to provide resources, fill in the gaps where there previously weren’t solutions, and make athletics safer and more accessible to students is important to us at the Concussion Center.”

“The toolkit makes the information about concussion signs and symptoms much more accessible for everyone in the community,” she said.

The toolkit includes a “signs and symptoms” poster outlining the physical, mental and emotional signs of a concussion, and a link to the Michigan Sport-Related Concussion Training Certification course, a free resource that satisfies the state and MHSAA-mandated requirement for concussion training.

The center also created specialized flowcharts to guide coaches, administrators and families while students go through the process of concussion management, care and classroom return, which is overseen by the athlete’s medical provider. The flowcharts provide additional resources for parents, for example, a list of common questions for doctors, and also address return-to-learn and return-to-play guidelines.

Allyssa Memmini, a doctoral candidate at the U-M School of Kinesiology, provided the guidelines using clinical best practices regarding return-to-learn and sport. These include recommendations for academic accommodations, as well as a graduated return-to-sport protocol for coaches to use as a resource to ensure student-athlete safety as they engage in sport-related activities.

To improve access to care, the toolkit included information on HeadStrong Concussion Insurance (PDF) provided by the MHSAA. This program offers up to $25,000 for concussion medical expenses, including follow-up care, and is open to every athlete who participates in an MHSAA -anctioned event or practice.

“We wanted to make the information about the insurance program more accessible to parents. A lack of insurance coverage should never be a barrier to helping an athlete get the appropriate medical care following a concussion,” said Mark Uyl, executive director of the MHSAA.

McEvans said there is unequal access to resources within the Detroit population.

“We have families that have every resource imaginable at their fingertips or can afford any resource that is out there, but we also service a lot of families that don’t have access to adequate medical care or have access to top facilities,” she said. “For us, it’s critical that we bridge that gap wherever we can.

“To bring in the U-M Concussion Center and all their resources and credibility helps us stand in the gaps and advocate for our families to get the best care and support that we possibly can provide them.”

Jay Alexander, DPSCD executive director of athletics, said the U-M Concussion Center partnership is invaluable.

“What they bring to the table is not just a road map, but the ability for us as a district to instruct more effectively about concussions and the role our coaches play in trying to help our student-athletes through concussions,” he said. “Whenever you enter into any positive partnership, it can continue and go in multiple places. I love the fact that it’s the University of Michigan because the university has large resources and we would love to continue to tap into that.”

Steve Broglio, director of the U-M Concussion Center, echoed Alexander’s thoughts.

“The partnership with DPSCD has been inspirational,” he said. “Their openness to co-develop an educational and procedural toolkit for coaches, parents and administrators demonstrates their leadership and commitment to the safety of their student-athletes. We are pleased to be a part of that process and looking forward to an ongoing and fruitful relationship.”

Center faculty member writes essay responding to DCMS Committee report

Adam Finkel
Adam Finkel

Concussion Center faculty member Adam Finkel, clinical professor of Environmental Health Sciences at the University of Michigan School of Public Health, wrote an essay for the British Safety Council magazine titled “Brain injury in sport: why the House of Commons report falls short.” Finkel wrote the essay in response to the Digital, Culture, Media, and Sport (DCMS) Committee of Britian’s House of Commons July 2021 report “Concussion in Sport,” which highlights the potential for long-term risk as a result of participation in sport.

“I give the July 2021 report Concussion in Sport, written by the Digital, Culture, Media and Sport (DCMS) Committee of the House of Commons, a ‘one hand clapping’ review. In places, it’s a brilliant repudiation of the ‘manufactured doubt’ that has plagued the issue of brain disease in contact sport, but it offers only self-regulation in response, and more disappointing still, it offers a brand of voluntarism that addresses past problems more than it seeks to prevent future ones,” writes Finkel.

Read his entire response here.

Care Consortium study highlighted in Michigan News

Steve Broglio smiling
Steve Broglio

Director Steve Broglio highlighted the Care Consortium study “The Natural History of Sport-Related Concussion in Collegiate Athletes: Findings from the NCAA-DoD CARE Consortium,” during an interview this week with Michigan News. He talked about how normal concussion recovery time could take upwards of a month before an athlete can be cleared to return-to-play.

The study found that though median recovery times were consistent with the previously suggested 14 days, it was not until one month post-injury that most athletes were cleared for unrestricted sport participation.

“Normal return-to-play time was previously set at 14 days–meaning 50% of people recovered in that time. Our paper suggests that 28 days more fully encapsulates the recovery process. At that point, 85% of people have returned to play,” Broglio said.

Read the full article here.

Broglio interviewed by WXYZ-Detroit

Steve Broglio smiling
Steve Broglio

Concussion Center Director Steve Broglio was interviewed by WXYZ-Detroit for their news story “Should tackle football be banned for youth under 14? Michiganders weigh in on debate.” The story focuses on the public service announcement featuring Brett Favre encouraging parents to wait until age 14 before allowing children to play tackle football. Broglio appears at the 3:25 mark.

Watch the full news story here.

Center member studies influential factors on adults allowing children to participate in contact sports

Children running after soccer ball.

University of Michigan School of Kinesiology PhD candidate Allyssa Memmini has published research studying factors that influence an adult’s decision to allow a child to participate in contact sports. 

Published in the Journal of Athletic Training, the article “Evaluating adult decision-making modifiers in support of youth contact sports participation” evaluates the perceptions of adults with and without children.  

According to Memmini, this is one of the first papers to do so.

Memmini’s analyses suggested female parents were more inclined than male parents to allow a child to play contact sports, especially football, ice hockey, and soccer. Her analyses also showed that previous adult sports participation, an increased number of children, and a child’s gender influenced the decision-making among adults with children. 

When it came to sport-related concussions, parents who indicated their own prior concussions were less likely to allow contact sport participation; however, those parents who had greater confidence in their own concussion knowledge were more likely to allow contact sport participation. 

Previous participation in football, hockey, and soccer also increased the likelihood of adults without children supporting contact sport participation.

Memmini was surprised by one area: both groups of adults were less inclined to support a daughter participating in a contact sport compared to a son. She theorized that adults may label certain sports as either “masculine” or “feminine” and push a child towards sports perceived as more socially suitable.

Allyssa Memmini headshot
Allyssa Memmini

“Some of the themes we uncovered open the door to look into how gender schema theory influences adult decision-making in terms of youth sports participation,” Memmini said. 

Memmini also saw a trend tied to parents’ educational levels. Adults with children who had a bachelor’s degree or higher were more inclined to allow a child to participate in all contact sports, especially soccer, when compared to adults with children who did not have a college degree. Adults with bachelor’s degrees or higher were also less likely to allow participation in football. Adults without children who had bachelor’s degrees or higher were less likely to allow participation in football and hockey and had decreasing support for youth contact sports. However, those adults who identified as medical practitioners were 2.3 times more likely to support youth contact sport participation.

Memmini said these results tell her that more information may need to be provided to parents as to what sports are considered “high-risk” for concussion.

“This work is emphasizing that adults may need further advocates to help them understand some of the risks their children may be enduring depending on which sport they participate in beyond football and ice hockey,” she said.

Finally, Memmini suggested that adults talk to a local athletic trainer to get more information. 

“An on-site athletic trainer may be able to answer some of those questions parents may have, especially in youth athletics,” she said. 

Center Speaker Series: Dr. Stanley Herring

Stanley Herring flyer Youth Sports Concussions: Addressing the Athlete with Persisting Symptoms

Dr. Stanley Herring joined the University of Michigan Concussion Center and local and national guests on Thursday, July 22, 2021, for the virtual presentation “Youth Sports Concussion: Addressing the Athlete with Persisting Symptoms.”

His talk focused on youth athlete concussion recovery and the effect of word choice when talking to patients and how that influences an athlete’s view of their concussion and ongoing symptoms. According to Herring, the shift from discussing “persistent concussion symptoms” to “persisting concussion symptoms” provides patients with the hope and belief that they can recover from symptoms that last longer than expected. 

“The word persistent means that this exists for a long time; it’s inclined to persist and exists for a long time. It implies unremitting, unrelenting,” Herring said. “Whereas persisting continues to exist past the usual time or normal time, but does not imply unremitting or unrelenting. So what does the word persisting do? It offers hope.”

Dr. Herring is a clinical professor for the Department of Rehabilitation Medicine, Neurological Surgery and Orthopaedics, and Sports Medicine at the University of Washington. He is also the co-medical director of the UW Medicine Sports Concussion Program and the senior medical advisor and co-founder of The Sports Institute at UW Medicine. He serves as a team physician for the Seattle Seahawks and Seattle Mariners and is a major contributor to the successful passage of the Zackery Lystedt Law in Washington State. The Zackery Lystedt Law prohibits young athletes who were suspected of sustaining a concussion from returning to the game without the approval of a licensed healthcare provider. Herring’s continued work helped pass similar legislation in all 50 states and the District of Columbia.

You can view his entire presentation here.  

As part of its ongoing quarterly speaker series, the center will be welcoming Dr. John Leddy, clinical professor in the Department of Orthopaedics at the University of Buffalo Jacobs School of Medicine, on Thursday, October 28, for the talk “Concussion: Physiology informs Treatment.”

Faculty Spotlight: Kristen Schuyten

Kristen Schuyten headshotKristen Schuyten, the performing arts rehabilitation program coordinator at Michigan Medicine’s MedSport, is a physical therapy clinical specialist with board certification in sports.  Kristen is also a certified strength and conditioning specialist and performs staff training in the screening, evaluation, and treatment of musculoskeletal injuries for University of Michigan performing arts patients. She also coordinates and performs on-site triaging, backstage treatment services, and has established a referral network for U-M’s School of Music, Theatre, and Dance (SMTD) students. For the past decade, she has also coordinated the injury-risk screening for SMTD including analysis of individual screenings and customized exercise prescriptions.

We sat down to speak with her about her career, her concussion work within SMTD, and her return-to-performance protocols.

Michigan Concussion Center: Can you provide us with a summary of your career path?

Kristen Schuyten: I got my undergraduate degree from U-M before simultaneously completing my master’s and doctorate in physical therapy at Central Michigan University. I worked in the Grand Rapids area for a year before working with performing arts students at U-M MedSport. My background as a dance student during my undergraduate and graduate studies gave me a familiarity with this patient population. I understood their injuries and how to treat them effectively. I felt this was an obvious area of need in the world of physical therapy because the healthcare providers I saw for my injuries had a general sports background but didn’t understand how to help me progress through my dance-specific injuries. I am now treating these performing arts patients and continuously working to make myself more knowledgeable on dance injuries because research continues to be limited.

Dancers tend to have better balance, eye movement, and vestibular functions, so they are a unique population to assess and treat. Throughout my career, I have noticed that dance students and faculty share the same concerns as I did regarding their unique movement patterns, goals, and injury patterns. We were able to form a partnership with SMTD and develop screenings to decrease musculoskeletal injury risk. There were also concerns from a neurological perspective because of the challenge to accurately progress dancers when they presented at NeuroSport with a concussion.  There was no established baseline assessment to refer to prior to their head injury, and in working with our neurologists, athletic trainers, and PTs, we have formulated a comprehensive neurological baseline and return to dance protocol for them.

Additionally, I grew concerned about the lack of mandatory concussion education, training, and baseline assessment (unless they are involved with high school athletic associations or at the NCAA level). My work is novel at Michigan in trying to address this area of concern.

MCC: Is there a difference between a physical therapy clinical specialist and a regular physical therapist?

KS: Yes. A clinical specialist is a job position you apply and interview for with your colleagues and administration.  A clinical specialist is responsible for staff education, training, and helping with any clinical competencies, especially post-op patients. A clinical specialist also acts as a bridge, through communication and programming, between staff clinicians and administration, working to help with clinic flow and providing experience to guide newer clinicians and assist them as needed.  Over the past year, I’ve participated in multiple staff-wide presentations developed by our course committee, spoke at the Women in Sports Medicine and Rehabilitation Symposium, and helped assist various staff with professional development.

MCC: When people hear the term “concussion,” their first thought often goes to contact sports. However, you work with concussed performing arts students regularly. How did you get interested in this area of concussion and what should people know about this population?

KS: When patients would see me for physical therapy, they shared their concerns that their previous providers didn’t know how to handle their care. Additionally, I could only find case studies dealing with dance-specific concussion issues. As a result, we started concussion baseline testing five years ago, and it was at least six or seven years before that we started doing musculoskeletal baselines.

A majority of dance is partner or group work. Concussions can happen during improvisational dance where the dancers don’t necessarily know the patterns or choreography. For theater and drama students, concussions mainly occur during training where they miss their cue on a punch or sword fight and get hit. There is also a concern with the crew working backstage and all of the rigging, staging, and lights that could serve as equipment involved in concussion.

Sometimes concussions happen when they’re outside of practicing for class or a performance, whether it’s a slip and fall or car accident. I’ve had some patients get a concussion after getting up too quickly and hitting their heads on a dorm bunk. The after-effects are going to dictate what they can do for performance because of the amount of auditory, visual, and cognitive processing they do. There is no way they can escape it. A performer’s movement is deeply embedded in their class activities; their return-to-performance must be integrated. For example, an instrumentalist isn’t going to have as much cardiovascular exertional demand as if they were running sprints, but they have so much sensory processing information affected by a concussion because they are reading sheet music while playing an instrument.

MCC: What role do you play in concussion care and treatment?

KS: While I generally do more on the education side, I also look at the baseline assessments and get that information to the neurologists and doctors at NeuroSport so they can be prepared if the dancers present in our clinic.

I assist in creating a performing artist’s return-to-performance protocol by incorporating the available published research out there. Through collaboration with our multi-disciplinary team and in coordination with the SMTD Wellness Initiative, we have developed protocols, education, and provide information for the medical provider down to the student. 

MCC: How are the return-to-performance protocols you developed the same and different from those for athletes in traditional sports?

KS: Musical theater has components of dance embedded within it (along with the speech work and vocal needs). When you look at musical theater and dance specifically, the performer undergoes a lot of body rotation. The performer could be rotating in a transverse plane where they’re turning their head around and around with their body staying erect, or end-over-end if tumbling. The manner of rotational work is very different compared to most other sports. When spinning, there is the need for the head to whip around as fast as possible for the body to continue spinning and stay upright. This will challenge a performer’s vestibulo-ocular reflex, their spatial awareness, their proprioception, and their balance because they tend to balance on the ball of their foot or a ballerina on the few square inches of her pointe shoe box.

When we look at how the return-to-learn is embedded within their return-to-performance, this is the double-edged sword. When you see concussed athletes, there’s a separation of what they can do academically versus what they can do on the field. An athlete can work on increasing heart rates and exertion levels while not having any screen time or facing limited time in the classroom. Meanwhile, a performer has all those variables intertwined, which makes it more challenging for the student, faculty member, administration, and health care providers.

Let’s use a ballet dancer as an example. When I work on a return-to-performance protocol for a ballet dancer, the language I’m using is more universally accepted in the dance world and the progression can be less variable. First, dancers watch a class to see if they can handle the motions. If they can, we move onto the basic skill elements because we are trying to limit anything that could potentially increase any type of brain activity. There are stepwise progressions after that. Ballet dancers go from performing stationary movements to activities that cause their body elevation to change. They can fully participate in the ballet barre once they show no symptoms from that activity. Performers then move onto center work, where there is not the ability to hold onto something for balance. This also increases auditory and visual stimulation because they will be watching people dance around them.

If they can handle light center work without having any symptoms (e.g., headaches, nausea, or vomiting), they can move onto further solo activities before progressing to partner work. Bigger rotational activities get added in, starting with head movement and inversion activities. Finally, they might go through performance marking and motions before they are allowed to fully participate in live performances.

MCC: You will be presenting “Setting the Standard: Education, Baseline Assessment and Return after Concussion in Dancer” at the International Association of Dance Medicine and Science Symposium in October. Can you tell us a bit about what you are hoping the audience will learn from your talk?

KS: This current topic will focus on implementing our concussion baseline testing for performing arts students and how we are addressing the gap in knowledge and education at U-M.

For instance, I teach the UM dance department’s anatomy and physiology course. I usually spend a week mid-semester lecturing on concussions. Initially, there was a request by the administration to teach the topic at the beginning of the semester.  The first year I taught the course one of my students sustained a concussion and she immediately knew what to do. She knew what was happening in her brain and I was able to work that much closer with her for her return-to-learn because I was her instructor as well.

Even though it was an unfortunate situation, it is a good example of how much-needed that education is. In my course, the students get a basic anatomy lesson while understanding why we do the baseline assessments, what the concussion signs and symptoms are, and know what to do after someone sustains a concussion. However, this is only the dance department students and is not consistent throughout all departments in SMTD.

The presentation that I am giving in October will showcase the work we have done and continue to do at Michigan on an international stage, while also allowing for building connections with other clinicians and dance educators. 

 MCC: Talk about the collaborations you have with the Concussion Center and what excites you about being a member of the center.

KS: I’ve been thrilled to have been provided opportunities (and resources) for faculty to get involved more in concussion care and research at Michigan. I was able to help connect a couple of my former patients to the center to serve as part of their Concussion Champions program. Second, I was also able to give my opinion and advice on the return-to-learn policy that PhD student Allyssa Memmini is working towards.  Allyssa and I are working together on the development of faculty education through the implementation of surveys to the SMTD faculty and staff and look forward to working together to develop more widespread educational programming and return to learn and return to performance protocols in the future. 

The center has also helped me quite a bit. The staff and faculty expertise can further some of the performing arts initiatives and address some of the areas of need within the performing arts community at U-M, but nationally and internationally as well.  I am thankful for these connections and this center as I know the work done here will greatly help the University’s performing arts population, but also the performing arts community as a whole.

Faculty Profile: Bruno Giordani

Dr. Bruno Giordani is a professor in the Michigan Medicine departments of Psychiatry, Neurology, and Psychology, as well as the U-M School of Nursing. He is the associate director of the Michigan Alzheimer’s Disease Research Center, the chief psychologist for the Department of Psychiatry, and the senior director of the Mary A. Rackham Institute. Dr. Giordani’s research includes neuropsychological, electrophysiological, and imaging approaches in the assessment of cognitive change, emphasizing cross-cultural and low-resource settings and computer-based cognitive assessment and training. He is a longtime fellow in two Divisions of the American Psychological Association—Society of Clinical Psychology (Division 12) and Neuropsychology (Division 40).

We sat down with Dr. Giordani to discuss his concussion work and interests.

Michigan Concussion Center: Talk about your career path. How did you become interested in neuropsychology?

Dr. Bruno Giordani: I started in graduate school studying psychophysiology at the University of Virginia. I was examining how the cardiovascular and other different body systems respond to social or even physical (e.g., cold pressor) challenges My curiosity was piqued as to how different body systems can respond in different ways, and I switched over to neuropsychology to better understand how cognition and brain systems affect a person’s ability to respond to challenges in their environment.  Eventually, I just got lost in neuropsychology and brain/behavior relationships.   

After graduate school, I did an internship in clinical psychology at the University of Virginia, with much time spent in our Epilepsy Center and EEG laboratory.  After that, I got a postdoc position in neuropsychology at the University of Michigan.  Here, I became more and more interested in brain changes from injury and aging.  I was a postdoc during the start of the Michigan Alzheimer’s Disease Research Center and the Positron Emission Tomography (PET) center, so there was lots to do. After my postdoc, I was recruited to Mount Sinai in New York to their Aging and Alzheimer’s program and stayed there until returning to Michigan. 

MCC: When did you realize you were interested in concussion?

BG: I gained experience in neuropsychology while in graduate school at one of the first national epilepsy centers, which in turn landed me a job in a neurosurgery department at the University of Virginia through my internship time. The department was particularly interested in traumatic brain injuries (TBI), so I saw many patients from mild to severe TBI.  We routed all concussion or head injury cases to the UVA Medical Center, as there were no other hospitals or primary care centers in the outlying areas.  During this time in the 1980s, no one considered mild TBI or concussion an issue to discuss.  We were able to publish a series of papers (perhaps the first) on mild TBI, highlighting the issues involved and the clear problems we saw for some persons, especially those without strong support programs at home or work.  Three months after injury, we still had about a third of persons previously employed who had not returned to work.  People simply didn’t believe this. This led to another paper on moderate TBI that found the return-to-work predictors were dramatically different from those in mild head injuries. The predictors in mild TBI were primarily age, education, support factors, and socio-economic status. We discovered that socio-economic factors played a key role in return-to-work. Our moderate and severe studies showed the key role that injury-related factors played.  We looked at other populations to study, including boxing and hockey and so I left Virginia with an idea that I could bring this work to Michigan, but it just didn’t work out.  At the time there was just no interest here in bringing these issues forward.  That is quite a bit different, now.  

MCC: What is the role of a neuropsychologist in managing concussion, and where does one fit within the areas of concussion prevention, management, and treatment?

BG: Simply put, the role of the neuropsychologist is to give a good picture of how a patient is doing cognitively and academically at the time of the assessment and then to provide expectations for what may happen over time and to help provide options for care and planning in return to athletic activities, school, or work. The role of the clinical neuropsychologist is not just to administer computer or paper-and-pencil measures as “laboratory values.”  The interpretation and assistance piece is important.  There is a difference between the computerized tests that may be given as part of an evaluation at the time of concussion and return to play with how that relates to academic success.  We are dealing with student athletes and we have to pay as much or more attention to the return to academics as everything else.  We help develop a model for how someone may have looked before the injury and work that information into better understanding of their recovery.  Our tests can help do that, clearly.  Behavioral and personality issues and motivation for academics, these all can be affected by concussion.  Saying that concussion explains it all is just not sufficient.  All the risk factors, such as past injury, past educational experiences, learning or attention difficulties, or mood and motivation, they all have to be considered.     

I think Michigan NeuroSport has a good model of how they see concussion cases. They look for initial cognitive complaints but don’t assume the patient looks fine. A lot of patients get neuropsych evaluations, and in some cases, it’s a more complex issue due to pre-existing learning and attention deficits or other issues involving return to play or return to academics. It’s important to have a good cognitive assessment to predict what a return-to-school plan is going to look like and to keep monitoring for changes over time. I have seen attention disorder issues as a long term follow-up problem after students return to school.  Good discussions and coordination with the student, their family, and their schools are important. 

MCC: What other kinds of concussion research have you done and are interested in?

BG: I have been doing some TBI work in Africa with some of my past trainees there. In Uganda, for example, folks ride on boda bodas, our equivalent of a cab, except they are motorcycles, and they are driven between and around traffic all day and all night.  In the evenings and nights, the emergency departments are full of head injury and trauma cases from boda accidents. We have done an initial trial follow up of patients who have been in the emergency room who have been treated and discharged after mild or moderate injuries, and who continue to have cognitive difficulties well into the future. This is really interesting and important work, but funding is hard, especially at this time.  

MCC: There is data suggesting a link between concussions and CTE, which some believe is a form of Alzheimer’s. Can you talk about the link between the two? 

BG: Alzheimer’s is dictated by localized deposits of amyloid in specific areas of the brain.  Certainly there is also a downline factor of tau abnormalities in those areas as the disease progresses, however. In CTE, you don’t see that same pattern—Tau deposits, often around blood vessels, are the key. So you can say they are linked by a decline in function and effects on the ability to complete basic adaptive living tasks, but there is a heavy overlay of behavioral deficits often in CTE that doesn’t appear early in most forms of true Alzheimer’s (though there are some types of dementia that show that early in the course).   Now, given that fact amyloid appears in the brain maybe 20 or more years before there are any symptoms in Alzheimer’s and that tau is an integral part in the appearance of symptoms in Alzheimer’s, it makes you wonder about certain individuals being far higher at risk for combined CTE and Alzheimer’s disease. It’s possible that if you followed patients who had the brain pattern of CTE on tau scanning, you might see the development of Alzheimer’s earlier, but that hasn’t been done yet.

MCC: What other research would you like to tell us about?

BG: My aging and dementia work, here, has led to a number of interesting things lately, including a very large grant in collaboration with other colleagues here and at U-M Dearborn Engineering.  Given that driving is an everyday complex activity with lots of attention and problem solving needed, we are looking at whether we can use everyday driving to warn us of the earliest signs of cognitive decline.  This work involves a lot, with a simulator, fixed course, longer naturalistic driving, and lots of information collected from the car and from high tech ways of collecting physiological data from the driver. Drivers’ cars are fully outfitted with monitoring systems, as well.  

I also spend a fair amount of time (during non-COVID times) doing research overseas in different parts of Sub-Saharan Africa.  This work is a real passion and interest of mine.  We have also been able to take part in quite a bit of resource building there, to the point that our African colleagues are turning out more grants than we are.  I have primarily worked with children in Africa to do something different than aging, here.  We first looked longitudinally at cognitive and behavioral issues in children with malaria and HIV or exposed to HIV. We developed our computer cognitive-based training paradigms on what areas of cognitive and behavioral deficits we saw in both of these patient groups, especially as they tried to return to school.  We have had good luck with our computer training paradigms, showing changes up to a year following training in terms of cognitive and behavioral measures.  It is interesting that only recently, I have managed to bring my aging research to the African side, where we are now looking at computer based training and learning paradigms that hopefully will assist older HIV patients at risk for further cognitive decline. 

MCC: What do you see as the current barrier towards the next level of understanding of concussion?

BG: I think the variability in concussions. The question is, how does the work people do in labs with accelerometers and helmets translate to the real world where people fall differently? A neurosurgeon by the name of Tom Gennarelli talked about seeing two patients have essentially the same injury, same type of fall, outside of his office, but the two individuals had dramatically different outcomes from their concussions (though their jobs were similar). People are built differently and get hit differently, and that is why imaging may be so important. The utility of more complex imaging such as Diffusion Tensor Imaging (DTI) that is now used more extensively for head injury and the use of other types of imaging and blood-based biomarkers is really interesting.  It will be exciting to see how the Concussion Center will leverage these approaches.

MCC: What excites you about being a member of the Concussion Center?

 BG: It’s amazing to me that there is a center here where people are willing to talk about real areas of concern and talk about the research that will direct us towards solutions.  The work Steve [Broglio, director of the Michigan Concussion Center] and others here have done in looking at lingering effects of concussion is really interesting. Our campus is growing rapidly with multiple centers and institutes all begging to look at different aspects of the same problem or how different problems share issues.  The Concussion Center, hopefully, will explore the interactions they may have.  For example, there is an opportunity, here, to join a number of other centers on campus studying aging with impressive databases of patient health information, including those with or without cognitive concerns. There might be a real way to move concussion and head injury history into these studies or just considering how to look at all of the older individuals out there who take falls.  We often are worried about broken hips, but how many of these individuals have cognitive deficits as a result of hitting their head as they fell?  There are a lot of interesting things to consider.  It is interesting and a lot of fun. 

Additionally, the work NeuroSport does is critically important. They look at injured high school athletes, conduct neuropsych testing, and make predictions for how the athletes should return-to-school and play. These types of clinical issues are critical and provide a wealth of potential research avenues.  The synergy of the Concussion Center and NeuroSport Program is a great opportunity for researchers at Michigan.

Understanding the impact of sensation-seeking on concussion

Spencer Liebel, a clinical neuropsychology postdoctoral fellow in the University of Michigan Department of Psychiatry, is expanding his passion for sport related concussion research with Dr. Steve Broglio, director of the University of Michigan Concussion Center, and co-PI of CARE Consortium.

Liebel is the first author of the article “Sensation-Seeking and Impulsivity in Athletes with Sport-Related Concussion,” which seeks to understand how an individual’s sensation-seeking may influence their risk and incidence of sport-related concussion. 

“We’re always trying to find ways to not only treat and manage concussions but also prevent them and the first step of doing that is the identification of risk factors,” Liebel said. “Identifying these risk factors can help us intervene with certain individuals to prevent concussions.”

Liebel describes sensation-seeking as an individual’s need for novel and exciting experiences that may also be inherently dangerous. He gave examples of someone jumping out of a plane, climbing Mt. Everest, or driving a race car.

Liebel used the Brief Sensation Seeking Scale (BSSS-8), which is a self-report questionnaire given as part of the CARE Consortium baseline assessment, to measure the degree to which an individual will seek out and engage in risk taking behavior. Participants were asked multiple questions such as whether they were more likely to want to go out versus stay in and if they would rather or rather not go bungee jumping.  An individual’s answers are added together to determine their sensation-seeking score.

Overall, the study found that among those who participated in higher-contact sports like football or ice hockey had higher levels of sensation-seeking than those playing lower-contact sports like basketball. They also found very low levels of sensation-seeking in individuals who participated in non-contact sports like golf or track.

“What it showed us is even in the absence of concussion, sensation-seeking appears to be highest in those individuals who have a preference for higher-contact sports,” Liebel explained.

Liebel also discovered that, among CARE Consortium athletes, a one point increase in sensation-seeking conferred a 21% greater risk for having had a concussion prior to being enrolled in the study. When he used the CARE Consortium data to look at athletes who sustained a concussion during study participation, he found a one-point increase on the BSSS-8 resulted in a 28% greater risk of concussion.

“What we’re seeing is that sensation-seeking accounts for quite a bit of an individual’s proclivity for having both prior and future concussion,” he said.

According to Liebel, this study was the first-of-its-kind to explicitly examine sensation-seeking in collegiate athletes. “It had been measured in amatuer rugby teams in Australia and was used to look at substance abuse and sexual behavior in adolescents, but this was the first to look at collegiate athletes with or without concussion,” Liebel said.

This isn’t the only concussion work he has done during his time at U-M. He helped study the efficacy of computer based assessments (led by PhD student Lauren Czerniack, PhD from Michigan’s Industrial and Operations Engineering) and found that they are comparable but still must be used as part of a broader assessment protocol.

For Liebel, studying concussion goes hand-in-hand with the field of neuropsychology. He said that a neuropsychological exam is already a component of a concussion assessment, and as a neuropsychologist, he is drawn to people suffering from traumatic brain injuries. He knew he wanted to go into the field after taking a behavior neurology class during his undergraduate studies and saw a clear way to marry his scientific interests with his passion for sports.

After he finishes his postdoctoral residency, Liebel will join the faculty at the University of Utah’s Department of Neurology and the Traumatic Brain Injury and Concussion Center where he will continue to conduct concussion research and contribute to the clinical care of athletes.

Concussion Center Scholars Program launched

The University of Michigan Concussion Center has launched its Concussion Center Scholars Program thanks to a generous $2M endowed gift.

“We are, of course, thrilled about the generous gift we received and are excited to use the funds to support students through the Concussion Center Scholars Program,” said Dr. Steven Broglio, the center’s director. 

The program aims to give University of Michigan students opportunities to work alongside center researchers, faculty, and staff members in various research and academic environments. “I’m excited to bring together the research needs of our faculty with an opportunity for students to engage in the important work of the center,” said Carrie Morton, the center’s deputy director.  

Over the past year, the center ran a pilot program that enabled students to assist with baseline concussion testing for U-M varsity athletes and complete data analysis in clinical care. Suzanne Cardozi and Danielle Destiny, both 2020 graduates, assisted with the baseline testing.

“We gathered information about their reaction time…which is important because if they do get a concussion we can see how it affects them and when they can safely return to play and school,” said Cardozi, who majored in Movement Science. She said she uses the experiences gained from baseline testing daily during her time studying physical therapy at Northwestern University.

Destiny, a Biopsychology, Cognition, and Neuroscience major, learned about clinical research through her experience. “I discovered it is something I want to do in the future at medical school and beyond,” she said. 

The pilot also gave Neuroscience and Moral Philosophy senior Melvin Darwin the opportunity to perform data analysis for the center’s clinician faculty, where patient data from Michigan Medicine is moved into the research space.

“I was not in the position to take on unpaid research, so this  program made my work with the Concussion Center possible,” Darwin said. “I worked alongside great PIs and research assistants who are doing cutting-edge research central to concussion science.”

The Concussion Center looks forward to expanding this program as the endowment grows.

More youth report concussions since 2016, U-M study shows

Philip Veliz
Assistant Research Professor
School of Nursing

New research from center faculty member Phil Veliz, assistant research professor at the University of Michigan School of Nursing, shows self-reported concussions have increased by 20% since 2016.

During that same time period, youth who reported one concussion rose from roughly 14% to 18%, and those who reported at least two concussions increased from about 6% to 7%.

“Self-reported concussions could be increasing given that both children and parents have greater knowledge with respect to these injuries. We have seen a greater effort in the U.S. to educate the population regarding the risks associated with head injuries and may have greater knowledge with respect to symptoms associated with these types of injuries,” said Veliz.

Read the full article here.

Concussion faculty member assists on FDA cleared TBI blood test

Dr. Fred Korley and the i-STAT Alinity blood test
Dr. Fred Korley and the i-STAT Alinity blood test

“For the very first time, we have a blood test for the brain,” said Dr. Fred Korley, associate professor of Emergency Medicine at Michigan Medicine and faculty member at the Michigan Concussion Center.

On January 11, Abbott, a global healthcare technology leader, announced they had received 510(k) clearance from the FDA for the i-STAT Alinity blood test, the first rapid handheld traumatic brain injury (TBI) blood test. This test will help clinicians assess individuals with suspected TBI by allowing them to measure blood levels of glial fibrillary acidic protein (GFAP) and ubiquitin carboxyl-terminal hydrolase L1 (UCH-L1), two complementary biomarkers that, in elevated concentrations, are strongly associated with brain injury.

According to Korley, GFAP and UCH-L1 are found within two of the most common types of brain cells, astrocytes, and neurons. When brain cells are damaged, GFAP and UCH-L1 are released into the brain, where they are picked up by blood vessels and circulated throughout the body. 

i-STAT Alinity requires a small blood sample drawn from which plasma is extracted with a centrifuge and applied to the test’s cartridge. The cartridge is then inserted into the handheld instrument, with results returning in 15 minutes. A negative result can be used to rule out the need for a brain CT scan, which is commonly used to help diagnose TBI and identify life-threatening bleeding in the brain. 

For those testing positive, this test result complements a brain CT scan by providing additional information regarding the extent of brain injury. 

Korley said this handheld device has the potential to be a “game-changer.” He noted that only nine percent of TBI patients evaluated in the emergency department have a positive brain CT scan. “With this test, we can identify those who need a brain CT scan a lot sooner and save some people from getting the associated radiation, and financial costs, and send them home quicker,” he said. “Furthermore, down the line, we may be able to provide additional information that we cannot provide right now.” 

The TBI blood test was developed in collaboration with the U.S. Department of Defense (DoD),  which has been dedicated to developing a solution for the objective detection and evaluation of TBI for more than a decade. The DoD, through U.S. Army Medical Research and Development Command’s (USAMRDC) U.S. Army Medical Materiel Development Activity (USAMMDA), played a critical role in funding the development of these tests that run on Abbott’s i-STAT Alinity platform. The Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) research team has led a number of cutting-edge studies that demonstrate how this TBI blood test can be used for the benefit of TBI patients in clinical care.

TRACK-TBI, of which Korley is an investigator, is an 18-center research network conducting the largest observational study on TBI across the United States. The study collects blood samples from patients who come into the emergency room for TBI care, including control subjects (healthy patients, friends of TBI patients, etc.), and follows them longitudinally for up to 12 months after they leave. 

Korley serves on the Biomarker Committee for TRACK-TBI, where he helps analyze blood-based biomarker data and guides data interpretation. He also helps write manuscripts to share the group’s findings and improve clinical care.

Currently, the biggest problem for diagnosing TBI, according to Korley, is that there isn’t an objective way to tell how severe the TBI is. “Only a small portion of TBI patients have an injury that results in bleeding into their brain, however, there are a lot of people who suffer injuries that put them out of work for more than six months, however, they don’t have significant findings on their brain CT,” he said.

Korley is optimistic that there may be opportunities to use the i-STAT beyond the TBI space, for detecting brain injury from non-trauma-related conditions. “It’s a whole new world,” he said.

Faculty Profile: Dr. Philip Veliz

Philip Veliz
Dr. Philip Veliz Assistant Research Professor
School of Nursing

Dr. Philip Veliz is an assistant research professor at the University of Michigan School of Nursing’s Applied Biostatistics Laboratory and is associate director of the Sport, Health, and Activity Research & Policy Center. His research primarily involves examining large-scale secondary data sets to assess adolescent substance use, health, and participation in organized sports. As a data analyst, Dr. Veliz has published extensively using data sets like Monitoring the Future, Youth Risk Behavior Survey, and the Office of Civil Rights Data Collection, and continues to work with new and existing data sources that focus on substance use and health. He also currently sits on the Michigan Concussion Center’s Faculty Council.

We sat down with Dr. Veliz to discuss his background, his research, and why he is excited to become a member of the Michigan Concussion Center.

Michigan Concussion Center: Tell us a little bit about your background and how you became interested in studying organized sports and concussions.

Dr. Philip Veliz: I am an applied statistician and I study large-scale secondary data that is given to the United States population with a focus on sports and sports injuries. I became interested in this topic while working on my PhD in sociology; for my dissertation, I tried to understand if sports participation was good for adolescents. Roughly 75 percent of the US population has participated in some competitive sport during their life, so my big, overall question was, “If you participate in sports, are you going to have a better health outcome?”

In doing my research, I became interested in learning if concussions were problematic for adolescents, and I asked myself if this was something I could analyze with secondary data. However, I couldn’t find any national estimates on concussions from adolescents in the data I was looking at. So I was able to work on getting a question added to a national survey with respect to concussions, and what I discovered is that one out of five adolescents reported having a concussion by the time they were in high school. My research also showed that participating in sports is one of the strongest predictors of sustaining this type of injury.

MCC:  From the data you looked at, what were some of those health problems you saw in adolescents?

PV: Right now we find some strong correlations between someone who suffered a concussion and substance abuse, particularly binge drinking, tobacco, and marijuana use, even when taking sensation-seeking (thrill-seeking) into account. However, we cannot say for certain that concussion is causing teens to use these substances. For instance, if someone is having a hard time concentrating after suffering a concussion, that individual might move towards stimulants to help concentrate better in the classroom. In other instances, people may be self-medicating with alcohol or marijuana because they are trying to deal with the injury in the short term. There is also the reverse, that if you’re more likely to binge drink, the more likely you are to get injured. We haven’t disentangled the causal mechanisms, but it’s not a far stretch to think that someone might be self-medicating with substances to try and get a sense of normalcy back following a concussion.

MCC: What other research have you done on concussion?

PV: As I mentioned before, one of the first studies I did was this national survey of adolescents, and what we found was that one out of five kids reported having a concussion during their lifetime. Additionally, we found, in association with that, the kids who reported concussions were playing sports, particularly contact sports. So the data showed the odds of someone reporting a concussion in their lifetime increased substantially if they participated in a contact sport.

The other study we completed was to look at concussion rate by each sport, and what we found was that football, ice hockey, lacrosse, and wrestling (high-contact sports) were the ones with the highest prevalence of adolescents saying they had a concussion. One in four kids indicated they sustained a concussion playing those sports, so those are the sports you want to monitor and make parents aware of the risks.

MCC: What can we learn by using these massive data sets when looking at concussions?

PV: With respect to these large nationally representative datasets, we can learn how many people in the population suffer from these types of injuries and can pinpoint if there are specific subgroups who are at greater risk for these injuries. This can help targeted interventions for specific subgroups who may suffer more severe consequences from these types of injuries.

MCC: What do you see as the next level barrier for your work in concussion?

PV: One of the biggest barriers is how difficult it is to get the concussion histories of older adults. It’s hard to find, if it even exists at a national level. I think it’s one of those things we have to start considering, given there is such a large population of adolescents who are being concussed. This is going to have long-term implications as they start to age. This isn’t a new phenomenon; it’s been going on for years. So there is an aging population that we can look at now, but we just don’t have that information to kind of do some of the easy correlational studies to help inform prevention strategies.

MCC: What excites you about being a member of the Michigan Concussion Center and serving on its Faculty Council?

PV: I get to communicate with people who are doing much different work than what I’m doing. As a data analyst, I come in asking the broad questions of “Have you ever had a concussion?” The clinical people I get to work with can give me a background on what the answers mean and walk me through the difficulty of measuring a concussion because it’s not simply just asking someone if they had a concussion. They can be difficult to diagnose based on the severity. So those are some of the things I like to listen in on, and it allows me to think of better ways to begin measuring what a concussion is so when I include questions on surveys, I get better information. I enjoy getting some pushback from members who are doing clinical work.

What I like about serving on the Faculty Council is the opportunity to give feedback on some of the exciting projects the center is working on. I can give advice on which direction we could go for data collection to make it more representative of the populations we are trying to assess.