VSCC Quarterly Newsletter                                               Summer 2023 

Vanderbilt Sports Concussion Center

Vanderbilt Sports Concussion Research 

Journey with Traumatic Brain Injury Research

We interview our associate professor of surgery, Mayur Patel, MD, MPH, FACS, FCCM to discuss TBI care and research. 

Position Specific Helmets

The NFL will be offering position specific helmets for the first time in the upcoming 2023 season.

Providers Spotlight

This issues spotlight features Siobhan Godwin, MHScPT, BScKIN, FCAMPT, FAAOMPT, Diploma Sport PT, RISPT.

V-TASC Lecture

If you missed our recent lecture "What You Should Know About Sport-Related Concussion: What The Science Actually Tells Us." with Dr. Pieroth, you can watch it here!

Student Spotlight

Our student spotlight highlights fourth year medical student, Jacob Jo, BA.

Consensus Statement on Concussion in Sport - 2023 Updates

We review the newly released documents from the 6th International Conference on Concussion in Sport.

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Co-Director's Message 

As many of you know, most medical centers end their year on June 30th and start a new year on July 1st. With this, we want to update you on some of the comings and goings related to the Vanderbilt Sports Concussion Center (VSCC).

We are excited to be working with a variety of summer students from other medical centers, including:

Connor Long (East Tennessee State University)

Dane Wagner (Florida State University)

John Dugan (University of Tennessee)

Tayler Corley (Undergraduate- Mississippi State University)

We want to congratulate the newly minted Dr. Alan Tang, MD, for graduating medical school and matching to the neurological surgery residency program here at Vanderbilt University Medical Center. Alan has been working with us for several year as a medical student at Vanderbilt, and we’re ecstatic that he will be around for another 7 years!

Lastly, we wanted to acknowledge our Director of Research, Aaron Yengo-Kahn, MD, who will be moving to Salt Lake City in the coming days to finish his training as a pediatric neurosurgeon at the University of Utah. Aaron started working with the Vanderbilt Sports Concussion Center when he was in medical school and has been a pivotal part of our mission as a neurosurgery resident over the past 7 years. We’re wishing Aaron the best of luck – he’ll be missed!

And we would be remiss if we didn’t include some pictures of VSCC family expansions that have happened over the past few months!

            Emma Williams                            Asher Zuckerman                           Aubrielle Godwin

Journey with Traumatic Brain Injury Research

with Dr. Mayur Patel, MD, MPH, FACS, FCCM

Concussion is a form of mild traumatic brain injury (mTBI), and sport-related concussion (SRC) is an even smaller subset specific to sports. Traumatic brain injury (TBI) encompasses a broader range of head injury, classically categorized into mild, moderate, and severe based on a variety of clinical characteristics. TBIs are responsible for over 50,000 deaths per year in the US with a global annual incidence estimated at 30 to 70 million, making it a major source of mortality and morbidity worldwide. In an effort to understand the current state of TBI research and his work thus far, we reached out to Mayur Patel, a Professor of Surgery at Vanderbilt University Medical Center. He was recently appointed as the Ingram Chair in Surgical Sciences, and the Division Chief of Acute Care Surgery in our Department. 

Dr. Patel completed his BA at Johns Hopkins University where he worked in a lab focused on translational research and later went on to earn his MD and MPH from Vanderbilt University School of Medicine. He then completed a General Surgery residency at Duke University Medical Center. Dr. Patel also completed fellowships at Duke and Vanderbilt and has been working at Vanderbilt since 2009. Dr. Patel currently serves as an Acute Care Surgeon across trauma, emergency general surgery, critical care, and burn areas. He has a strong focus on TBI care and research. 

TBI Care

Although much of concussion care is done on the sidelines and/or at a general practitioners office, more severe TBIs are often handled differently. To get a better idea of the care pathways for these patients we asked Dr. Patel about his clinical expertise. 

KW: What is your experience with caring for patients with TBI? 

Dr. Patel: "On the trauma service, we see a lot of in-patient hospitalized individuals with a variety of co-occurring injuries that require medical stabilization and surgery. The patients may have a form of concussion although many unfortunately go undiagnosed due to the technology that we have. Of the multiple thousands of patients that we encounter, about half of them have some form of TBI. Much of that is defined by the very black and white CT scan showing blood on the brain. Our team of acute care surgery ends up coordinating the care as they often have broken bones or other internal organs that may be bleeding and damaged and trying to strategize the best care in concert with doctors in the neurosurgery team. It's a really difficult area to be a clinician in because there are a lot of unanswered questions for families regarding if their loved one will be able to return back to their life and to work. These are the kind of things are we're interested in trying to answer, but currently don't have those answers."

In the setting of these the unknowns associated with brain injuries, we asked Dr. Patel what he wished every patient would know about concussions or TBI. 

Dr. Patel: "Concussions have sort of been branded in an interesting way and people just sort of think of them differently, but they are a form of brain injury. It would be better if it was branded as a brain injury that didn't require you to go to the hospital. But it is a brain injury, it's serious. It's been isolated out and I really think it should be part of the whole traumatic brain injury conversation. Which it is at the Vanderbilt Sports Concussion Center - but patients and other people might over minimize what it is. I think the term 'concussion' just needs to get moved out of the lexicon."

Through the years, concussion care has evolved from playing through the injury, to strictly recommending rest, and more recently introducing active recovery as a treatment tool. Recommendations for post-injury care are constantly changing as more research becomes available. We spoke with Dr. Patel about where he would like to see concussion care go in the future. 

KW: How would you like to see concussion care evolve?

Dr. Patel: "I think there's a lot of exciting blood biomarkers. Dr. Terry and I have been on a lot of the conversations scientifically that are out there deciding if people need imaging and are there any modalities to sort of better quantify a diagnosis. Especially for those with repeat exposures in the sport or military arena. I think it's helpful to know the impact or the recurring impact of these injuries and a lot of people just write it off."

TBI Research

In conjunction to his clinical work, Dr. Patel continues to focus on his research on the management of TBI and related topics. We asked about his current projects and future initiatives.  

KW: Can you tell us about your TBI research thus far, and which topics you're interested in continuing to research? 

Dr. Patel: "I am interested in the intersection of traumatic brain injury for the hospitalized folks as well as those that suffer from sickness and illness that cause their brain to be dysfunctional, even if they don't have a traumatic brain injury.

People with sepsis, pneumonia, COVID, and other disorders come into the hospital needing medical and surgical care for these illnesses - and during the course of their illness, their brain goes on some dysfunctional pathway. We call it delirium which can occur in up to 48% of critically ill patients. The cognitive deficits in one-third of these survivors are comparable to Alzheimer's disease or moderate traumatic brain injury despite never having a traumatic brain injury. Now imagine the same patients who have traumatic brain injury also get pneumonia and all these other things that are critically ill, so you're getting kind of a double hit to the brain and that's the area I'm interested in."

"It's an exciting place to be and that's part of the reason that we're at places like Vanderbilt. It's a major point of being here. Our major mission is to figure out how to do things better, how things work, and yes, we also have the bedrock of taking care of patients. But that sets us apart from other community hospitals. This is one of the few places that you can kind of figure out how to do that, do that well, and make that part of your career."

Research in any field comes with its own set of challenges and presents learning curves throughout. With multiple years of experience under his belt, Dr. Patel shares some of the challenges he had to overcome, lessons he had learned, and advice regarding research and collaboration.

Dr. Patel: "I didn't always have great partners like, Dr. [Doug] Terry and Dr. [Scott] Zuckerman and other people in the VSCC. I had previously turned in grants, funding agencies who are accustomed to having neurologists, neurosurgeons, and neuropsychologists apply for grants - but are kind of unfamiliar with general surgeons. They associated general surgery with conditions like appendicitis and gallbladders - which is true - but didn't realize our central involvement in patients with traumatic brain injuries. While neurosurgeons perform one aspect of the patient's care, the trauma service often coordinates a lot of the patient's care. Caring for these patients is team effort - almost like a symphony orchestra working together."  

Provider Spotlight:

Siobhan Godwin, MHScPT, BScKIN, FCAMPT, FAAOMPT, Diploma Sport PT, RISPT

Siobhan Godwin is a physical therapist at VUMC in the Department of Physical Medicine and Rehabilitation. Siobhan is a valuable member of our VSCC team, and we are honored to highlight her in this issue. Siobhan started working at Vanderbilt in 2020 and treats patients from Vanderbilt's orthopaedic, spine, sports medicine, and concussion populations. Siobhan provides a unique physical therapy perspective to the VSCC interdisciplinary team, assists with concussion research studies involving physical therapy, and provides treatment to concussion patients seen at the VSCC. Our own Kristen Williams (KW) had the opportunity to sit down with Siobhan and hear about her time at Vanderbilt. 

KW: Where are you from originally and what brought you to Vanderbilt?

SG: "I was born in Ottawa, Ontario, Canada and moved to Toronto, Ontario to work at Sports Medicine Specialists (now the Cleveland Clinic Canada) in 2012. I met my husband in 2017 who is a singer/songwriter in Nashville, then we got married and I moved to Nashville in 2019. I originally came on a work Visa to coach figure skating at the Scott Hamilton Skating Academy. After 1.5 years of physical therapy equivalency courses, I completed the US board exam and obtained my green card. I started working at Vanderbilt in 2020. I was drawn to Vanderbilt because of its reputation as a leading hospital in the southeast, its world-renowned care, and it's exceptional team of healthcare providers, more specifically, its innovative sports concussion program that is continuously building and striving for excellence in education, research capacity, and patient care."

KW: What is one thing about caring for sport-related concussions in athletes you would like the public to know?

SG: "If we can determine the underlying driver behind a patient's symptoms, as well as the physiological systems involved, then we can tailor treatment to be specific and individualized and optimize recovery for our patients."

KW: How have you seen concussion care change over the course of your career? 

SG: "At the start of my career, it was still recommended that concussion patients rest until asymptomatic before partaking in a return to play protocol. So, my role as a physical therapist on the concussion care team was fairly limited. As the guidelines have adapted, patients are now recommended to take a few days of relative rest and get an early start on active rehabilitation. PTs now play a large multifaceted role in the concussion rehabilitation process including assessment and treatment of the cervical spine, vestibular system, oculomotor system, and autonomic system."

Fun Facts:

Siobhan is married to musician Mike Godwin. They have 2 little girls, Salem (2.5 years old) and Aubrielle (5 months old) and a King Charles Cavalier named Nash (4 years old). 

Coming from the North, Siobhan and her family love skating and skiing, but they also enjoy the warmer weather and outdoor activities such as swimming, running, hiking, and playing tennis.

Siobhan has an extensive background as a national and international level figuring skater with 15 years of competitive experience in the discipline of ice dance. 

Research Corner

The VSCC would like to highlight a few of our recently accepted manuscripts. Great work and congratulations to all authors! (click the pictures to access the articles)

Position Specific Helmets

Student Spotlight:

Jacob Jo, BA

Jacob Jo is a fourth-year medical student at Vanderbilt University. Jacob joined the V-SCoRe research team in July 2022 after receiving the Vanderbilt University School of Medicine Medical Scholars Program Fellowship, which allows him to collaborate on research projects full-time for one year. Since joining the VSCC Jacob has assisted with over 30 unique research projects making him one of our most productive team members. Jacob plans to apply to Neurosurgery match in the fall of 2023 to start his neurosurgical training in July 2024. Our own Kristen Williams (KW) sat down with Jacob to learn more about his experiences with V-SCoRe. 

KW: How has V-SCoRe impacted your medical education?  

JJ: "I have always envisioned a career in academic medicine, where research and clinical practice complement one another. I imagine a future where half of my time is spent helping patients and the other half leading a productive research effort, answering the very questions encountered in clinical practice. I believe I was able to check all the boxes I was hoping to check prior to starting my research year. First, I wanted to develop the autonomy of taking project ideas and taking them to the finish line. Second, I wanted to be in a position of being able to mentor younger medical students in research. Both of these skills I wanted to develop prior to starting residency so I could be productive during residency, and my research year has helped me accomplish those. I am tremendously grateful to my mentors Drs. Zuckerman and Terry for their continued guidance."

KW: What is the most valuable lesson you’ve learned so far working with V-SCoRe?  

JJ: "Research is an absolute team sport. From study design and data collection to writing the manuscript and submission, everyone on the team (i.e., all the authors) need to be on the same page, be in agreement with objectives, and approach the effort with a teamwork mentality. With that, productivity will follow. Throughout the year thus far, I have realized this both through working with mentors and students at Vanderbilt and colleagues from other institutions. I believe that this is one of the most valuable things to know in research."

KW: Why did you want to get involved with V-SCoRe?

JJ: "Towards the end of my third year of medical school, I had a change of heart regarding specialty, from orthopaedic surgery to neurosurgery. At that point, I took an honest, introspective look at my career path and spoke with many attendings and residents from both fields. One of those conversations was with Dr. Zuckerman, who shared his perspectives on neurosurgery as a career path and spoke about his similar career crossroads while a medical student at VUSM. I also spoke with Dr. Yengo-Kahn, who shared his experience with the VSCC and passion for concussion research. After meeting with Dr. Zuckerman and Dr. Terry, and hearing about various research opportunities, I became excited at the prospect of dedicating a year to clinical research under their direct mentorship. Here, I saw a future where my passion for research, neuroanatomy, and clinical neurosurgery could come together."

Fun Facts:

From Tenafly, New Jersey

Jacob participated in rowing, wrestling, and boxing in high school and went on to continue rowing and boxing at the collegiate level. 

Jacob plays the cello and was introduced to music at a young age by his mother who is professional classical pianist. If not for medicine, he may have pursued classical music in another life. 

Consensus Statement on Concussion in Sport - 2023 Updates

The sixth International Conference on Concussion in Sport Group (CISG) took place in Amsterdam in October 2022. This conference draws hundreds of providers, researchers, and experts in the field of concussion together to discuss, summarize, and implement concussion management strategies for people involved in sport-related concussion (SRC) care. Before this, the most recent international consensus took place in 2016, when the commonly used Sport Concussion Assessment Tool 5 (SCAT5) was published. 

After 5 years of systematic reviews and expert opinions, concussion recommendations were updated and new assessment tools were released. Guidelines continue to highlight the importance of concussion prevention as well as the '11 Rs' of SRC. With the addition of information and assessment tools we felt it would be beneficial to summarize some of these important changes. A few of the impactful changes include:

- An updated definition of concussion

- Addition of 'RETIRE' and 'REFINE' to the existing 'Rs' of SRC

- Five new concussion assessment tools (CRT, SCAT6, Child SCAT6, SCOAT6, and Child SCOAT6)

Concussion research played a crucial role in providing these updated recommendations. As a sport-concussion research group, we are excited to explore, implement, and focus future research studies on these updated guidelines and measures. 

Look for our next Newsletter

Fall 2023!

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If you have any questions about the VSCC Quarterly Newsletter, please reach out vscc@vumc.org

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