The alumni study is co-led by Dr. James Eckner, associate professor in the Department of Physical Medicine and Rehabilitation and associate director of research for the Concussion Center, and Dr. Philip Veliz, assistant research professor at the U-M School of Nursing. Both Eckner and Veliz spoke with Michigan News and The Detroit News.
Also quoted in the stories was Jarrett Irons, former All-Big Ten linebacker and U-M Football co-captain in the mid-1990s, who now serves on the Concussion Center’s Advisory Board.
*Note: You will need a subscription to read The Detroit News article.
Our faculty members spoke, and we listened.
During the U-M Concussion Center’s series of faculty workshops, research coordination support was identified as a key strategic enabler needed to advance concussion research at the University of Michigan, especially for new pilot projects and discrete research tasks. To meet our ongoing faculty members’ needs, the center welcomed two new staff members, Michaela Broadnax and Matthew Morley, who will provide research support tailored to research teams’ needs.
Broadnax serves as the center’s research area specialist and Dr. Eleanna Varangis’ (assistant professor of Movement Science, School of Kinesiology) research laboratory manager. Broadnax previously worked as a lead research coordinator at Case Western University School of Medicine and outreach coordinator for the Cleveland Alzheimer’s Disease Research Center (CADRC). According to Broadnax, she analyzed qualitative data, trained research staff members, collected quantitative data, nurtured institutional and community partner relationships, and gathered preliminary data on recruitment needs for underrepresented populations on three National Institute of Health funded grants during her tenure at Case Western and CADRC.
During her time at the CADRC, she learned that people who suffer a concussion or a traumatic brain injury (TBI) are at a higher risk for Alzheimer’s disease (AD) later in life. “Often, people focus on the short-term risks (of concussion): ‘When can I play again?’ When can I go back to work?’ or ‘When can I drive again?’ versus treating it while keeping the long-term effects in mind,” said Broadnax.
She can now marry her research interest in brain injury and neurocognitive decline by examining concussion effects on neurocognitive function in adulthood and continue studying ways to treat brain injury for the prevention of cognitive decline.
Broadnax added the center’s multi-disciplinary approach, in addition to Dr. Varangis’s goal of examining the long-term effects of concussion, was the perfect fit for her.
“My experiences as both a clinical research and outreach coordinator have prepared me to take on any challenge,” she explained. “I haven’t worked with just one research field, so this experience has prepared me to work with any given population and to have empathy while doing so. I also have experience collaborating across various institutions and working with diverse populations, which are critical to support the center’s research mission”
Matthew Morley brings a background in the social sciences, particularly an emphasis on research data management, collection, and education to his role as the center’s clinical research coordinator.
He spent the last ten years working at the University of Michigan Institute for Social Research (ISR). His first six years at ISR were with the Inter-university Consortium for Political and Social Research (ICPSR), one of the world’s leading data archives.
Morley said throughout his time at ICPSR, he worked on data management, curation, and documentation and developed data pipelines for federally funded projects.
From there, he transitioned to being a project manager for ISR’s Research Center for Group Dynamics, specifically the Aggression Research Group. Morley oversaw projects related to youth exposure to violence in urban cities like Flint, Michigan, and Jersey City, New Jersey. In addition to collecting and managing data, Morley helped with survey design, oversaw teams out in the field, and worked with project partners (U-M students and researchers, study participants, and community organizations).
According to Morley, data helps run the world.
“It’s even more critical in the health sciences because you can see how things develop. Whether it’s a pandemic or concussions, there is something wrong about what is taking place in people’s health, and that needs to be understood,” he said. “So, I’ve tried to throw myself into whatever I can to understand this world better.”
The center’s multifaceted commitment to research, clinical care, and public engagement drew him to the position.
“With my background in different aspects of research and the multifaceted nature of the center’s projects, I feel like I’m in an excellent position to help further the growth of these studies and facilitate the research and public engagement,” Morley said. “With my background in education, I can help with data management and collection and be a facilitator from the researcher to subject participants, community organizations, and health systems.”
He also has a personal connection to concussions. He played collegiate rugby at the University of Southern California in addition to being a lifelong football fan. While he was never diagnosed with a concussion, he had many teammates who were.
“There is a lot of ambition here (at the center). Everybody is great, super nice, and it just feels like you’re a part of something really important that is just getting off the ground,” Morley added.
“We are very excited about having Matthew and Michaela on board to strengthen our research core,” said JT Eckner, associate director of research for the center. “In addition to providing research support for our faculty members, they will be instrumental in building our Concussion Learning Health System (C-LHS), which will generate and translate concussion knowledge to improve patient care at the University of Michigan.”
Faculty can fill out applications for Discrete Task Support or Ongoing Projects on a rolling, ongoing basis. The current call for proposals will remain open through January 31, 2023, with project support availability as early as March 1, 2023.
To help foster a sense of community among University of Michigan Concussion Center members, the center hosted a Concussion & Cocktails research presentation in October featuring Hayley Falk, a PhD student in the Department of Computational Medicine and Bioinformatics, and Dr. Fred Korley, associate professor of Emergency Medicine.
According to Falk, there is not a well-defined model that can be used to predict outcomes for patients who come into the ED with an mTBI. Not having this type of model can become a barrier to improving patient clinical care because physicians in the ED are not able to quickly identify patients who would benefit from additional follow-up treatment and care.
She noted while the prognostic model still needs external validation, the study showed it has the ability to help identify those at risk of incomplete recovery and inform clinical care decisions in the ED setting.
Members in attendance asked questions throughout the presentation about the variables used in the model and how the Glasgow Outcome Scale Extended (GOSE) was defined. Following the presentation, discussions led by Dr. Korley, Falk, and various audience members centered around further concussion-specific applications for the model and how it could be used in different population settings.
The goal of Concussion & Cocktails presentations is to bring center members together in a casual forum to highlight member research and continue developing cross-campus relationships. The next Concussion & Cocktails event will take place in spring 2023. More information will be shared in upcoming Concussion Corners.
A study focusing on the racial and ethnic differences in concussed adult emergency department (ED) visits has begun to shed some light on health disparities in injury occurrences and patient treatment during ED visits.
Lempke and his team reviewed an estimated 4.5 million concussion-related adult ED visits from 2010-2015. Using race/ethnicity as the primary variable, Lempke began examining the relationship between ED visits, mechanisms of injury (motor vehicle accidents, sports-related falls, etc.), and whether patients underwent a CT scan during the visit.
According to Lempke, the data showed disparities in how people were injured and who received CT scans. Black patients were 2.69 times more likely to sustain a concussion resulting from a motor vehicle accident and 4.58 times more likely to sustain a concussion from “other injury mechanisms” compared to white patients. Additionally, non-Hispanic Asian, multiracial, or another race patients had reduced odds of falls compared to white patients,1. At the same time, CT scan data showed Latinx patients were 48 percent less likely to have CT scans performed during their visit than non-Hispanic white patients.
Lempke added that when accounting for sociodemographic variables, such as sex and payment type, there wasn’t any difference between individuals of different races and ethnicities seeking emergency department visits for a concussion.
“We identified that concussion visits in the emergency department did not differ by race or ethnicity when accounting for other factors, but there are still potential underlying problems in the injury mechanism and the health care decisions surrounding neuroimaging being made here. The next steps are seeing how we can prevent, or maybe even intervene, on these circumstances,” Lempke said.
This study serves as a follow-up to previous research by Jessica Wallace, assistant professor at the University of Alabama’s Department of Health Science, and Rebekah Mannix, associate professor of Pediatrics at Boston Children’s Hospital, which examined if racial and ethnic disparities existed in injury occurrence and diagnosis when children and adolescents visited the ED for a concussion.
Lempke, L. B., Kerr, Z. Y., Melvin, P., Walton, S. R., Wallace, J. S., Mannix, R. C., Meehan, W. P., & Ward, V. L. (2021). Examining racial and ethnic disparities in adult emergency department patient visits for concussion in the United States. Frontiers in Neurology. https://doi.org/10.3389/fneur.2022.988088
A study co-authored by University of Michigan School of Kinesiology PhD student Adrian Boltz examined over 1,700 sport-related concussions to understand if there were symptom patterns in male and female National Collegiate Athletic Association (NCAA) student-athletes.
Led by Avinash Chandran, Director of the NCAA Injury Surveillance Program at Datalys Center for Sports Injury Research and Prevention, “Patterns and predictors of concussion symptom presentations in NCAA athletes” collected data from the NCAA Injury Surveillance Program during 2014-2019 to examine the distribution of concussion symptoms in collegiate student-athletes across a variety of sports.
The group aimed to identify contextual predictors of specific concussion symptoms and symptom co-presentation patterns.
Boltz said the group evaluated 13 concussion symptoms related to a student-athlete’s physical, mental, emotional, and sleep well-being (domains). They considered the athlete’s sex, collegiate class year, sport type (contact vs. limited/non-contact), where the concussion occurred (practice or game), how the concussion occurred (contact or fall), and the athlete’s concussion history as relevant factors.
Results showed that headache, dizziness, difficulty concentrating, and sensitivity to light were the most common symptoms reported among male and female athletes.1 According to Boltz, the symptoms varied differently across the sexes. In males, difficulty concentrating, irritability, headache, drowsiness, and sensitivity to light had the strongest associations with symptoms across the four domains. At the same time, disorientation and hyperexcitability were strongly associated with mental and emotional domains.1
For females, odds of insomnia, nausea, and sensitivity to light and noise were lower in athletes participating in high-contact sports than those competing in limited or non-contact sports.1 Additionally, difficulty concentrating, hyperexcitability, sensitivity to noise, and irritability were strongly associated with symptoms across the four domains.1
Boltz added that the results showed that athletes took longer to recover if they showed more symptoms.
“This (study) allows us to get a deeper insight into the symptomology that follows the sport-related concussion,” said Boltz. “By doing so, we get a greater appreciation for what athletes should be perceiving after an injury.”
Boltz said that including women in the study was important because they have often been under-represented in the past.
“We understand that, in this day and age, people respond differently to certain injuries, and there appear to be sex-related differences as well. Now, having a robust sample of women in our study further substantiates not only our observations but the inferences that can be drawn from it,” he added.
According to Boltz, leveraging such a large sports injury database allows for “a greater sense and appreciation for the concussion symptom profiles of student-athletes.”
“This is an excellent representation, not only of the quality of work but rather what leveraging sport surveillance systems can suggest or provide commentary on as it relates to sport-related concussion research,” he continued.
Avinash Chandran, Adrian J. Boltz, Benjamin L. Brett, Samuel R. Walton, Hannah J. Robison, Christy L. Collins, Johna K. Register-Mihalik & Jason P. Mihalik (2022) Patterns and predictors of concussion symptom presentations in NCAA athletes, Research in Sports Medicine, DOI: 10.1080/15438627.2022.2105218
The University of Michigan Concussion Center made its presence known during the International Consensus Conference on Concussion in Sport in Amsterdam, Netherlands, from October 27-28, 2022.
Center Director Steve Broglio, along with Executive Committee members Drs. Matt Lornicz and Andrea Almeida (co-clinical associate directors and co-directors of Michigan NeuroSport), Dr. JT Eckner (associate director of research and associate professor in the Department of Physical Medicine & Rehabilitation), and Dr. Doug Wiebe (associate director of outreach & engagement and director of the U-M Injury Prevention Center); U-M School of Kinesiology Postdoctoral Research Fellow Dr. Landon Lempke and PhD students Adrian Boltz and Reid Syrydiuk, Dr. Michael Popovich (clinical assistant professor of Neurology at Michigan Medicine); and Dr. Abby Bretzin (research investigator in the Department of Emergency Medicine), represented the University of Michigan at the conference.
The International Consensus Conference on Concussion in Sport brought researchers together to present new research surrounding concussion and its definition, management,, treatment, return-to-play protocols, and long-term effects.
New research was presented by center members at the podium (Lempke & Boltz) and posters (Eckner, Lempke, and Syrydiuk). Broglio found his way to the podium as well, co-presenting a systematic review on return to school and sport followed by a moderated session on the same topics.
Lempke and Boltz were two of a select number of podium presentations chosen by the committee, which reviewed approximately 400 submissions. They each presented research from the National Collegiate Athletic Association (NCAA) – Department of Defense (DoD) Concussion Assessment, Research, and Education (CARE) Consortium.
Lempke’s work (“Early Exercise is Associated with Faster Concussion Recovery Among College Athletes: Findings from the NCAA-DoD CARE Consortium”) examined the benefits of light exercise on symptom recovery in collegiate athletes following a concussion. Boltz’s talk on “Differences in return to play time by race and sport type among university student-athletes: findings from the Concussion Assessment, Research, and Education (CARE) Consortium” evaluated time to unrestricted return to play time by race and level of sport contact at the time of injury.
Lempke was also selected to present his research poster “Reliability of the Standardized Assessment of Reaction Time (StART): Translating Functional Reaction Time from the Lab to the Clinic.” He tested the reliability and measurement properties of a clinical sport-related reaction time test he developed using commonly available clinical tools.
The center’s collaborative research efforts were on display as well. Eckner presented “A preliminary comparison of brain morphometry between youth American football and non-football athletes: a report using Adolescent Brain Cognitive Development (ABCD) Study data”, which was co-authored by eight center faculty members.
He co-authored the study with Lorincz, Almeida, Popovich, and center members Eric Ichesco, research lab special senior in the Department of Anesthesiology; Ingrid Ichesco, assistant professor in the Department of Pediatrics; Bara Alsalaheen, associate professor of physical therapy at University of Michigan Flint’s Department of Physical Therapy; Scott Peltier, research scientist in the College of Engineering’s Department of Biomedical Engineering; and Xuming He, professor of statistics in the College of Literature, Science, and the Arts.
The authors compared regional cortical thickness and subcortical gray matter volumes in 9-and-10-years-old children who play American football vs. non-contact sports.
Finally, Syrydiuk presented his master’s student work from the University of Calgary’s Sport Injury Prevention Centre. Working under Dr. Carolyn Emery, Syrydiuk examined the differences in head impact rates between a traditional 2021 12-on-12 Canadian youth tackle football season to a modified 9-on-9 2021 season that saw policy changes due to COVID-19 cohort and distance restrictions. He highlighted his research in the poster presentation “Down Three: Does a reduction in on-field players influence head impacts in Canadian youth tackle football?”
“It was great to see the Michigan Concussion Center so well represented at the 6th International Consensus Conference on Concussion in Sport,” said Eckner. “As a first-time attendee, it was enlightening to see the amount of advanced preparation put into the systematic reviews by the Scientific Committee, as well as the rigor of the review methodology.”
The new Consensus Statement on Concussion in Sport was drafted based on the findings of nine systematic reviews and will serve as guidelines for clinicians and healthcare professionals worldwide when treating concussed athletes.
The University of Michigan is fortunate to have Dr. David Millward returning to his collegiate roots, leading Michigan Athletics as the Medical Director/ Head Team Physician.
As a talented Canadian youth golfer, Millward played collegiate golf at Olivet College, less than an hour-and-a-half drive west of Ann Arbor. During this time, he fell in love with college athletics, discovered his interest in math and science, and married the two to begin a career in sports medicine.
“It was because of that love of sports that I had to find something I could do in a related field for a career,” said Millward.
To achieve his long-term career goal, Millward pursued a master’s degree in epidemiology from Michigan State University and moved to the University of Ottawa for his medical degree. He then completed his residency and fellowship at the University of Arizona and spent the next 14 years caring for its student athletes before accepting his current position at the University of Michigan.
“I always knew I wanted to come back this way to be closer to family. The University of Michigan was always on my radar as a top school because of its excellent academic and athletic programs. When the opportunity opened, I applied and was fortunate enough to get it,” said Millward.
Now that Millward is at U-M, he is looking forward to strengthening Athletic’s collaboration with the Concussion Center by serving on the Faculty Council and getting involved in various opportunities such as the newly launched “U-M Alumni Neurological Health Study”.
As a pilot, the study invites all U-M alums who graduated before 2012 to take a survey, helping researchers evaluates key neurological outcomes to shed light on the relationship between sports participation, concussion history, and long-term brain health.
“This study is important for several reasons. When looking back at a student athlete’s career, we can discover… potentially modifiable risk factors that can be applied to current student-athletes,” Millward explained. “It’s only by doing that research that we can identify problems that may not even have surfaced when they were here but are coming up later in life. Then, we can use that information to treat our current student-athletes better and help those struggling down the road.”
Millward is particularly interested in understanding the current research on concussion diagnosis and treatment, facilitating evidence-based management and treatment strategies when caring for student-athletes. According to Millward, Concussion Center’s research innovation informs he and the other team physicians and keeps them up-to-date on the latest care and treatment recommendations.
Over the past two decades, he has seen the evolution of the continuum of concussion care. For example, Millward indicated that the inclusion of return-to-learn and return-to-play strategies in follow-up care allows student-athletes to return to their pre-injury lifestyle with more support and fewer difficulties.
“We want to make sure that when (student-athletes) do return to play, they are doing it safely,” he added.
One of the clinical barriers Millward has had to overcome throughout his career is helping student-athletes navigate all the resources available on and off campus. He said that while student-athletes have access to top medical care, they don’t always know when to ask for what, which can delay their care. “That’s where we come in and help them find their way…to whatever care they need so that they can continue to reach their goals,” he added.
A group of researchers from the United States Air Force Academy, the University of Georgia, and the University of Michigan have identified that female athletes are under-represented in research efforts informing the three most influential concussion consensus statements and positions from the National Athletic Trainers’ Association (NATA), the Concussion in Sport Group (CISG), and the American Medical Society for Sports Medicine (AMSSM).
Across 171 research articles cited by the CISG, NATA, and AMSSM, the review found a “significant under-representation of females in athletes in their cited literature, relying on samples that were overall 80.1% male (NATA: 79.9%; AMSSM: 79.4%; ICCS: 87.87%).”1 Additionally, 69 studies (40.3%) had all male samples, while only two studies were all female (1.2%).1
“If we want to support female athletes, we need concussion protocols that give equivalent representation to what male athletes get,” D’Lauro said. “Right now, that is not the case. We need protocols that guide care for all athletes.”
The study offers five strategies to support the inclusion of more female and other athlete groups in future concussion research. The strategies include:
1. Facilitating equal representation of female, male, transgender, and non-binary authors on consensus and position statements, editorial boards, and program management.
2. Including female-focused sections of consensus and position statements until there is enough research for a standalone document.
3. Acknowledging the usage of predominantly male athlete samples to inform recommendations.
4. Creating consensus/position statement checkpoints to ensure the cited research is as balanced as possible.
5. Creating research funding opportunities focusing on women, non-binary, and transgender athletes or including a better balance between male and female athletes.1
The Concussion in Sports Group (CISG) met in Amsterdam, Netherlands, in October 2022 to update its consensus statement. D’Lauro added the group needs to be “more mindful of the diversity – or lack of it – in the data that informs the protocol.”
“Future editions should do a much better job of equitably representing female athlete data, and be more mindful of inclusion for data from other athlete groups too,” D’Lauro continued.
D’Lauro C, Jones ER, Swope LM, et al Under-representation of female athletes in research informing influential concussion consensus and position statements: an evidence review and synthesis British Journal of Sports Medicine 2022;56:981-987.
Center Director Dr. Steve Broglio was interviewed by multiple media outlets in regard to various issues surrounding concussions.
He spoke with CNN, Yahoo, and the Washington Post, and Fox News following the Miami Dolphins quarterback Tua Tagovailoa’s concussion during their game against the Cincinnati Bengals on 9/29. Tagovailoa was carted off the field, taken to a local hospital for evaluation, and released later that evening. This was the second incident that week of Tagovailoa suffering a blow to the head. On Sunday, 9/25, Tagovailoa’s head hit the field following a shove during the second quarter of the Dolphins’ game against the Buffalo Bills. Tagovailoa got up from that hit and shook his head before stumbling. He eventually cleared the NFL’s concussion protocol at halftime and played the second half.
Additionally, Broglio was featured in an Oakland Press story highlighting the decline in youth sport concussions around the state of Michigan following efforts to increase concussion education and awareness.
“I do think there has been a huge shift in the culture amongst players, coaches, and athletic departments in regards to taking concussions much more seriously,” Broglio said in the article. “That’s not to say anybody was intentionally doing harmful things 20 years ago. We just didn’t understand the severity of the injury back then. There has been a huge leap forward on the education side.”
Read “Michigan seeing youth sport concussions decline as laws around education strengthen” here.
The University of Michigan Concussion Center was proud to host Dr. Douglas Smith from the University of Pennsylvania on Thursday, September 29, as part of its Speaker Series presentations.
Smith, an endowed professor of teaching and research in Neurosurgery and director of the Center for Brain Injury and Repair at the University of Pennsylvania’s Department of Neurosurgery, discussed “What underlies concussion? A shadow network?” with a live and virtual audience focusing on what happens during a concussion and describing how the brain recovers from the injury.
Smith said a concussion isn’t “your brain bouncing back and forth like a nut in a shell, or that you have a contusion or a bleed (which are signs of a more significant injury).” He challenged everyone to think of concussions as a brain connectivity disorder, explaining that a concussion stretches and breaks the axons, the long, thin cables connecting neurons and sending electrical signals throughout the brain.
He also highlighted differences in male and female genetic risk factors for concussion, including the type of axonal injuries males and females suffer. According to Smith, female axons are smaller, have fewer microtubules (hollow rods in a cell that help provide its structure and shape) than males, and suffer more damage following a concussion than males.
Transitioning to recovery, Smith said there is a “shadow network” (as he calls it), a synchronous, micropatterned neural network consisting of nodes and axon lanes, that assists with recovery. He explained there is more than just a connection between two nodes with a primary function; the nodes also have axons connecting to other parts of the brain.
According to Smith, four nodes are grouped together with five axon lanes running between each node to form a parallel communication pathway for brain signals to travel on. Smith hypothesizes that when a concussion occurs, the axon lanes between two of the nodes are damaged. To assist with recovery, the nodes will, over time, begin re-routing the brain signals along the remaining in-tact axon lines between the other three nodes to form a new communication pathway the brain signals can follow.
He added future research could look at this network to help understand how outcomes differ in concussions before answering questions from the live and virtual audiences.
Eleanna Varangis, assistant professor of Movement Science at the School of Kinesiology, attended the presentation in person and was fascinated by Smith’s explorations of the various effects of concussion on the brain.
“I was compelled by his discussion of how the brain naturally builds in redundancies to functionally compensate in the face of concussive injury,” Varangis added. “This idea that each person’s brain develops a variety of different pathways to access the same information or processes is a great framework to explore how injuries can affect the brain and how people show varying levels of impairment after the same injury.
Laura Rowen, injury prevention/Michigan Safe Kids coordinator at the Michigan Department of Health and Human Services, attended the presentation virtually. “We are fortunate that our partners at the University of Michigan Concussion Center are able to bring experts like Dr. Doug Smith to share their information and knowledge with Michigan,” she said.
The next Speaker Series presentation will be in early 2023. Sign up for our U-M Concussion Quarterly Newsletter to be notified for future events.