VANDERBILT SPORT CONCUSSION CENTER
QUARTERLY NEWSLETTER
Summer 2024
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Rugby Mouthguards
World Rugby has instituted a smart mouthguard for players, read more below.
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| Nutrition Recommendations
Post-Concussion
We share some of the existing literature discussing nutrition recommendations post-concussion.
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NATA Bridge Statement
The VSCC continues in its efforts to provide a variety of concussion resources for parents of youth athletes.
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Providers Spotlight
This issue's spotlight features
Dr. Katie Gifford, PsyD.
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Student Spotlight
Our student spotlight highlights third year Vanderbilt Medical Student: Natasha Hughes, BA.
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| Research Corner
Check out some of the latest work being done in the Vanderbilt Sports Concussion Center!
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Vanderbilt Sports Concussion Center Conference
Updates on Sport-Related Concussion:
Recognition, Recovery, Retirement
If you were unable to attend the event, speaker presentations can be viewed on VuMedi. Link to sign up here.
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| V-TASC Lecture: July 23rd
Our most recent quarterly lecture featured speaker Dr. Thomas Buckley, EdD, ATC. If you missed the lecture you can view on our website here!
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Happy Summer!
Per usual, we’ve been busy with a variety of research projects – from looking at technological devices to see if they can help to diagnose a concussion by capturing abnormal eye movements (Eyebox and BlinkTBI) to examining whether former professional football players understand if starting football before age 12 is associated with higher rates of cognitive / psychological issues later-in-life.
Clinic is often slow for us during the summer, but as we gear up for fall sports, remember to stay hydrated and practice proper technique. Many preventable concussions occur when athletes are de-conditioned due to the off-season, as well as when they are more tired and fatigued from practice.
Best,
VSCC Co-Directors
Doug Terry
Scott Zuckerman
Andrew Gregory
Katie Gifford
VSCC Coordinator
Garrett Perry
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Nutrition Recommendations Post-Concussion
Kristen Williams
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Recovery from sport-related concussion (SRC) is a commonly discussed topic among the SRC research community. Many factors such as gender1, age2, and personal and family history have all been found to impact time to recovery following injury. Along with this, healthcare professionals may provide a variety of recommendations that can aid in recovery such as relative rest, limited screen time, school accommodations, low threshold aerobic activity,3 – and more recently – dietary supplements. A variety of supplements and nutritional considerations have been implemented in people recovering from moderate-severe traumatic brain injuries,4 yet few have focused on concussion recovery.
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Magnesium is one of the more commonly recommended supplements after concussion. It is important in regulating muscle and nerve function, blood sugar levels, and blood pressure by making protein, bone, and DNA.5 In a randomized cohort study of post-concussion patients, it has been shown to assist in decreasing symptoms within 48 hours after administration when compared to a placebo group.6
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Riboflavin (Vitamin B2) assists with energy production, cellular function, growth and development, and metabolism of fats, drugs, and steroids.7 Riboflavin may assist in managing migraines and headaches, and when paired with magnesium, may help in reducing the frequency and severity of headaches following concussions.8
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Another potential supplement for concussion treatment is omega-3 fatty acids. Omega-3s are important in maintaining the functions in your heart, blood vessels, immune systems, lungs, and endocrine systems.9 Although a few studies have investigated the impact of omega-3 fatty acids on concussion recovery, the evidence is not enough to make any definitive remarks.10
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Nutritional considerations following concussion is a rising topic yet further research examining the impact that supplements may have on concussion recovery is needed. In an effort to compile the most current literature, we created a Nutrition and Supplement Recommendations information handout for our athletes. Our hope is to provide some guidance on the dietary needs for athletes recovering from concussion.
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1. Kerr ZY, Chandran A, Nedimyer AK, Arakkal A, Pierpoint LA, Zuckerman SL. Concussion Incidence and Trends in 20 High School Sports. Pediatrics. 2019;144(5):e20192180. doi:10.1542/peds.2019-2180
2. Putukian M, Purcell L, Schneider KJ, et al. Clinical recovery from concussion–return to school and sport: a systematic review and meta-analysis. Br J Sports Med. 2023;57(12):798-809. doi:10.1136/bjsports-2022-106682
3. Patricios JS, Schneider KJ, Dvorak J, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport–Amsterdam, October 2022. Br J Sports Med. 2023;57(11):695-711. doi:10.1136/bjsports-2023-106898
4. Lucke-Wold BP, Logsdon AF, Nguyen L, et al. Supplements, nutrition, and alternative therapies for the treatment of traumatic brain injury. Nutr Neurosci. 2018;21(2):79-91. doi:10.1080/1028415X.2016.1236174
5. Office of Dietary Supplements - Magnesium. Accessed May 13, 2024. https://ods.od.nih.gov/factsheets/Magnesium-Consumer/
6. Standiford L, O’Daniel M, Hysell M, Trigger C. A randomized cohort study of the efficacy of PO magnesium in the treatment of acute concussions in adolescents. Am J Emerg Med. 2021;44:419-422. doi:10.1016/j.ajem.2020.05.010
7. Office of Dietary Supplements - Riboflavin. Accessed May 14, 2024. https://ods.od.nih.gov/factsheets/Riboflavin-HealthProfessional/
8. Trojian TH, Wang DH, Leddy JJ. Nutritional Supplements for the Treatment and Prevention of Sports-Related Concussion-Evidence Still Lacking. Curr Sports Med Rep. 2017;16(4):247-255. doi:10.1249/JSR.0000000000000387
9. Office of Dietary Supplements - Omega-3 Fatty Acids. Accessed May 13, 2024. https://ods.od.nih.gov/factsheets/Omega3FattyAcids-Consumer/
10. Ryan T, Nagle S, Daly E, Pearce AJ, Ryan L. A Potential Role Exists for Nutritional Interventions in the Chronic Phase of Mild Traumatic Brain Injury, Concussion and Sports-Related Concussion: A Systematic Review. Nutrients. 2023;15(17):3726. doi:10.3390/nu15173726
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Provider Spotlight: Katherine Gifford, Psyd
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| We are honored to highlight Dr. Katie Gifford in
this issue’s provider spotlight. Dr. Gifford is an Assistant Professor of Neurology, Clinical Neuropsychologist, and Co-Director of the Vanderbilt Sports Concussion Center. Dr. Gifford moved to Nashville almost 13 years ago to finish her training in neuropsychology and has been at Vanderbilt since. Dr. Gifford primarily sees athletes ages 12 and over with a history of concussion and is a huge asset to the Vanderbilt Sports Concussion Center as a clinician, researcher, and co-director.
Our own Kristen Williams (KW) had the opportunity to sit down and hear about her time at Vanderbilt and her experience with treating concussion.
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KW: Can you tell us about some of the research you are doing?
KG: "The majority of my research focuses on cognitive or thinking changes as we get older. I am interested in understanding what it means when someone says, “My memory is not as good as before - and that worries me.” Many people, including middle-aged adult and older adults, report changes to their thinking. Most of those people do not have Alzheimer’s disease or something wrong with their brain. We are learning how to best ask questions about memory/thinking to most accurately identify people at risk for abnormal aging. More recently, I am focusing on what it means when people with a history of head injury, including repetitive head injury, begin to think their memory or thinking is changing."
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KW: How have you seen concussion care evolve since the beginning of your career?
KG: "The most exciting change I have seen is the mindset that concussions matter and we should not just “power through” when we get a hit and have some symptoms. This recognition is across players, teammates, and coaches – though we still have to make additional progress to ensure everyone respects concussions when they occur. The second exciting change is the increasing amount of research on this topic, which is leading to better and more evidence-based treatments, like active recovery – as well as consideration of the risk factors associated with a prolonged recovery, and how it’s best to manage and treat these athletes."
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KW: How have you seen the VSCC change, and where do you see us going in the future?
KG: "VSCC has grown in the last 12 years since its inception. There is amazing research coming out of the Center and a wonderful group of clinicians helping athletes and others recover from concussion. I look forward to continuing ground-breaking research and knowledge about the mechanisms, consequences, and treatment of sports-related concussion – and letting that knowledge translate into top-notch clinical care of athletes."
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| KW: If you could choose 3 words to describe your approach to caring for athletes with concussion, what would they be?
KG: "Comprehensive, Active, and Personalized"
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| KW: What is one thing about caring for sport-related concussions in athletes you would like the public to know?
KG: "The importance of immediate removal from play, even with the smallest suspicion for injury and the positive impact of active recovery."
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| Fun Facts:
- Dr. Gifford is from Massachusetts
- She has one daughter who loves gymnastics, swimming, and bike riding.
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World Rugby Integrates Smart Mouthguards
Anna Peterson & Campbell Coleman
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Real-time mouthguard and head impact data has the potential to allow for immediate identification of potentially dangerous impacts, facilitating timely medical interventions.
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Rugby, a high-impact sport, subjects players to frequent collisions and tackles, leading to a heightened risk of concussions and repetitive head impacts (RHI). While not all head impacts result in a concussion, research has shown that RHI have the potential to be equally as harmful, although not yet fully understood.1-4 Traditional methods of monitoring head impacts rely heavily on subjective reporting and sideline assessments, which can be inconsistent and inaccurate. Smart mouthguards, however, provide objective real-time data enabling a more precise understanding of the impact burden on players. These innovative devices are equipped with sensors capable of measuring the frequency, magnitude, and direction of impacts sustained during play. Real-time mouthguard and head impact data has the potential to allow for immediate identification of potentially dangerous impacts facilitating timely medical interventions. Over time, the data can be analyzed to identify patterns and risk factors associated with RHI leading to the development of improved training protocols and safety measures. Moreover, the data from mouthguards can inform rule changes and enforcement. By identifying the types of impacts most likely to cause concussions, rugby governing bodies can adjust rules and regulations to minimize these dangerous encounters. This proactive approach aligns with broader efforts within other sports organizations to prioritize player welfare without compromising the integrity of the game.
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These innovative devices are equipped with sensors capable of measuring the frequency, magnitude, and direction of impacts sustained during play.
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World Rugby has decided to integrate smart mouthguard technology into their Head Injury Assessment protocol as part of a new phase of global player welfare measures.5 The introduction of smart mouthguards in international rugby represents a significant advancement in player safety, driven by growing concerns about RHI and their long-term effects on athletes' health.6 The data collected from these mouthguards offer a new dimension in monitoring and managing the risks associated with RHI. The smart mouthguards will work in real time to send alerts of high forces to the independent matchday doctor. This will, for the first time, enable players who have experienced a high acceleration event (peak linear at 75g and angular acceleration 4500 rad/s2 for men), but have not shown symptoms or been seen by broadcast cameras, to be taken off and assessed. The new protocol and technology were debuted in the elite women’s competition from October 2023 and were integrated into the Head Injury Assessment protocol as of January 2024.5 By providing objective, real-time data on head impacts, these devices can enhance player safety, inform better regulations, and contribute to our understanding of RHIs and concussions. As rugby continues to evolve, the integration of such technology marks a critical step towards safeguarding the long-term health and wellbeing of its athletes.
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1.worldrugby.org. World Rugby integrates smart mouthguard technology to the Head Injury Assessment as part of new phase of global player welfare measures | World Rugby. Accessed June 24, 2024. https://www.world.rugby/news/875212?lang=en
2.Walton SR, Powell JR, Brett BL, et al. Associations of lifetime concussion history and repetitive head impact exposure with resting-state functional connectivity in former collegiate American football players: An NCAA 15-year follow-up study. PLoS One. 2022;17(9):e0273918. doi:10.1371/journal.pone.0273918
3.Mainwaring L, Ferdinand Pennock KM, Mylabathula S, Alavie BZ. Subconcussive head impacts in sport: A systematic review of the evidence. International Journal of Psychophysiology. 2018;132:39-54. doi:10.1016/j.ijpsycho.2018.01.007
4.Kawata K, Rubin LH, Lee JH, et al. Association of Football Subconcussive Head Impacts With Ocular Near Point of Convergence. JAMA Ophthalmology. 2016;134(7):763-769. doi:10.1001/jamaophthalmol.2016.1085
5.McKee AC, Stein TD, Huber BR, et al. Chronic traumatic encephalopathy (CTE): criteria for neuropathological diagnosis and relationship to repetitive head impacts. Acta Neuropathol. 2023;145(4):371-394. doi:10.1007/s00401-023-02540-w
6.Stephen SJ, Hasman L, Goldenberg M, et al. Short-Term Neurologic Manifestations of Repetitive Head Impacts Among Athletes: A Scoping Review. The Journal of Head Trauma Rehabilitation. 2022;37(5):318. doi:10.1097/HTR.0000000000000767
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NATA Bridge Statement
Garrett Perry
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Athletic trainers will often spend more individualized time with athletes than any other health care provider during the recovery process of a sport-related concussion (SRC). Due to the amount of time spent with an athlete, athletic trainers should be experts in the current practice guidelines of an SRC. To guide care, the National Athletic Trainer’s Association (NATA) published its first position statement in 2004 which outlines concussion management recommendations and then released an updated position statement in 2014.1 Since then, concussion research has evolved, leading to changes in treatment recommendations and the need for updated guidelines. While the updated statement published in March 2024 has important additions, it only acts as an addendum to the previous statement from a decade ago.1
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The 2024 Bridge Statement covers every aspect of concussion management from assessment tools to return to sport strategy. A couple revisions to the previous recommendations include the frequency of cervical and neurological assessments, and individualized academic care plans.2 One new area of focus was on the benefits of light aerobic exercise (during which the athlete can have mild symptom increases), in contrast to previous recommendations stating athletes should avoid any physical activity that increased symptoms.2 Another newer recommendation is related to the utilization of the Vestibular Ocular Motor Screening (VOMS), which evaluates eye tracking, gaze stability, near point convergence, and nystagmus – as well as symptom exacerbations associated with these activities.2 This screening tool gives clinicians insight into factors that may delay recovery as well as identify athletes who may need specialized physical therapy. Lastly, due to increased attention for mental health following injury, the NATA now recommends screening for mental health conditions and the creation of policies to refer athletes who present with mental health symptoms/conditions.2 Additionally concussions are no longer to be thought of solely as a physical injury, but factors such as cultural, social, and psychological factors should be considered during treatment.2 There are many other updates and additions included in the full article. Athletic trainers should read through the full statement to safely and efficiently return athletes to the sideline. If you haven’t taken the time to read over the guidelines the link is attached.
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1.Steven P. Broglio, Johna K. Register-Mihalik, Tamara C. Valovich McLeod; Management of Sport-Related Concussion: Bridging the Evidence From 2014 to 2023. J Athl Train 1 March 2024; 59 (3): 223–224. doi: https://doi.org/10.4085/1062-6050-0490.23
2.Steven P. Broglio, Johna K. Register-Mihalik, Kevin M. Guskiewicz, John J. Leddy, Alejandra Merriman, Tamara C. Valovich McLeod; National Athletic Trainers’ Association Bridge Statement: Management of Sport-Related Concussion. J Athl Train 1 March 2024; 59 (3): 225–242. doi: https://doi.org/10.4085/1062-6050-0046.22
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We would like to take a moment to recognize the work that our team has accomplished over the last few months and share a few of our recently accepted manuscripts.
Congratulations to all authors!
Click the picture or link to access the full-length article.
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Subclinical, long-term psychological symptoms following sport-related concussion: are athletes more depressed than we think? Burns C, Jo J, Williams K, Davis P, Amedy A, Anesi TJ, Prosak OL, Rigney GH, Terry DP, Zuckerman SL. 2024. Brain Injury. DOI: 10.1080/02699052.2024.2334352. PMID: 38572738.
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Student Spotlight: Natasha Hughes
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Natasha Hughes is a third-year medical student at Vanderbilt University School of Medicine. Natasha joined our team in September 2023 and has assisted in several projects since. Natasha plans to apply to neurosurgery residency in the 2024-2025 cycle and hopes to pursue a career in academic medicine where she can balance a busy neurosurgical practice with research. Natasha has done exceptional work for the VSCC and we are eager to see what she accomplishes in the future. Our own Kristen Williams (KW) sat down with Natasha to learn more about her experiences with V-SCoRe.
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KW: Why did you want to get involved with V-SCoRe?
NH: "One of my research interests is in neurosurgical trauma, including traumatic brain injury and concussions. Concussions are a clinical entity that affects a mostly young and otherwise healthy population and can have many implications on these patients’ lives. Joining V-SCoRE allows me to fulfill my personal goal of further studying and characterizing the effects of concussion, and better understanding this entity through research may help us to achieve the broader goal of improving care for our patients"
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KW: What is something valuable that you've learned about concussions?
NH: "I’ve developed an appreciation for the complexity and variability of concussions. There is such a broad range of symptoms and symptom intensity across individuals who have sustained from a concussion – no two patients with a concussion are the same. This reinforces how important specialized concussion clinics are, as they connect patients with experts who can personalize their treatment plans."
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KW: What is the most valuable thing you have learned so far working with V-SCoRe?
NH: "V-SCoRe has emphasized to me the importance of teamwork in research; I have the great privilege of collaborating with so many different researchers who have taught me so much. Though many of these researchers and experts are senior to me, I’ve also learned from those junior to me! I’ve benefitted so much from the various insights that’s been shared with me from Dr. Terry, Dr. Zuckerman, Kristen, other medical students, athletic trainers, residents, and undergraduate students – just to name a few! What I’ve learned is that the help, collaboration, and curiosity of so many different individuals are ultimately what makes it possible to move the field forward and benefit patients recovering from a concussion."
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KW: How has V-SCoRe impacted your medical education?
NH: "V-SCoRe offers the opportunity to lead and ultimately execute a research project with the support of an incredible team of experts, encouraging independence and curiosity in students. Understanding how research is performed and being able to critically assess the literature are crucial aspects of being a physician, and V-SCoRe compliments medical education by giving students hands-on experience with this. Moreover, V-SCoRe is led by incredible mentors that are truly invested in the success of all of their students in their medical careers. I’ve been really grateful for all of the support of the entire team."
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| Fun Facts
KW: What is something about you outside of medicine/science?
NH: "I love to bake and to visit local bakeries. My family is French, so I’m very particular about French pastries and am always searching for the best croissant wherever I live. For my friends’ birthdays, I always ask them to name a baked good that they want and I make it – no matter what it is. I especially enjoy making cakes with lots of different layers to them, such as mousses, cheesecake filling, or fruit curds!"
-Natasha played basketball in high school, and also did martial arts for many years. She now enjoys weight-lifting and high intensity workout classes.
-Grew up in Calgary, AB Canada
VSCC Projects
Psychiatric, cognitive, and functional status outcomes in IPV-related head injury
Characteristics of non-sport related concussion, compared to sport-related concussions
Systematic review on atypical symptoms after concussion
Characteristics of concussion with concurrent neck pain
Patient-level predictors of delayed presentation to concussion clinic
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Look for our next Newsletter
Fall 2024!
Sign up for our email list here!
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If you have any questions about the VSCC Quarterly Newsletter, please reach out vscc@vumc.org
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