VANDERBILT SPORT CONCUSSION CENTER
QUARTERLY NEWSLETTER
Winter 2024
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Providers Spotlight
This issue's spotlight features
Dr. Mayur H Patel, MD.
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Student Spotlight
Our student spotlight highlights third year Harvard Medical Student, Grant Rigney.
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Research Process
Walk through the typical research process with us as we work to conduct exciting projects in our center.
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| Concussion Resources for Parents
The VSCC continues in its efforts to provide a variety of concussion resources for parents of youth athletes.
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National Sports Brain Bank (NSBB)
Here we discuss the goals and objectives of the University of Pittsburgh National Sports Brain Bank.
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Age of First Exposure
The age at which athletes begin playing organized sports is important, see the latest research here.
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We hope that you will join us for a few of our upcoming events:
The next V-TASC lecture, "
Contact Sport-Exposure and Concussion with Long-Term Outcomes: Modifiable Health and Lifestyle Factors Across the Lifespan" with speaker Dr. Benjamin Brett, PhD, will take place on February 20th, 2024. Please register for the event by clicking the button below!
The Vanderbilt Sports Concussion Center presents 2024 Concussion Conference, "
Updates on Sport-Related Concussion: Recognition, Recovery, and Retirement" on June 21st, 2024. Please visit our website for more information.
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As we start 2024, we want to thank all the providers at the VSCC for their excellent care this past fall, as well as thank all the patients and families who have trusted us with helping their loved ones recover from a concussion. In 2023, we conducted approximately 959 concussion visits across nearly all sports. Our research infrastructure continues to be strong, with 3 prospective studies enrolling patients who are actively recovering from a concussion, as well as several retrospective studies and systematic reviews. Several of our initiatives are designed around evaluating the new Sport Concussion Assessment Tool, 6th Edition (SCAT6), as well as examining the long-term health of contact sport athletes.
Further, we are excited to announce that we will be holding a one-day conference on June 21, 2024 at Vanderbilt Children's Hospital, titled Updates on Sport-Related Concussion: Recognition, Recovery, and Retirement. Be on the lookout for more information soon!
Best,
VSCC Co-Directors
Doug Terry
Scott Zuckerman
Andrew Gregory
Katie Gifford
VSCC Coordinator
Garrett Perry
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Youth and adolescent sports have played a major role in the lives of many children and families. With the playing age starting as early as 4-5 years old, athletic involvement may continue well into high school years, resulting in approximately 10-15 years of total formal sport participation. Sports provide children and adolescents with the opportunity to stay physically active and learn valuable lessons such as teamwork, selflessness, and commitment. Although there are many reported benefits to sport participation,
1 contact sports also expose athletes to a risk of injury, one of which being repetitive head impacts during practices and games that may or may not result in a concussion at the time of impact. Whether or not an injury has occurred the future implications of repetitive head impacts is actively being studied. In recent years, research has focused on examining the potential effects that early youth contact sport participation may have on future brain health.
The field of concussion research has developed the term 'age of first exposure' (AFE) or the age at which an athlete started playing contact sports. Studies have looked into the potential long-term health consequences associated with earlier AFE. So far, results of these studies have yielded conflicting evidence. One study – published in 2015 – which focused on 42 former National Football League (NFL) athletes suggested that participating in football before the age of 12 (AFE <12) may lead to worse cognitive function later in life.
2 This study, released one week before the 2015 Superbowl, received significant media attention. Since its publication, other clinicians and researchers have written a Letter to the Editor about the study, citing several limitations.
3–5 While one research group has continued to find differences between former athletes with AFE < 12 and those who started football later, many other studies found no such relationship between age of first exposure and poor long-term neurological outcomes.6–15 These studies have been conducted in both high school and collegiate
populations. While the topic of AFE to contact sports certainly remains an active area of research, it is undeniable that age of first exposure to contact sports and its potential relationship with poor neurological outcomes is a complex topic that requires further study. The data has not clearly elucidated who may be at risk for worse outcomes and why.
To improve the safety of youth sports, many youth sport organizations have moved towards increasing their safety regulations to reduce potential injury and to protect the health and safety of these young athletes. The unknown regarding future implications of youth contact sport participation may be unnerving to many. However, with the commitment to continued research on the topic, recommendations and safety measures will continue to ensure that youth sports are an enjoyable and safe experience for all athletes and families.
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Provider Spotlight: Mayur Patel, MD
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Dr. Mayur Patel is our featured provider for this issue. Dr. Patel started working at Vanderbilt in September of 2022 and has been a valuable member of our team since his arrival. Dr. Patel is a professor within the Department of Neurology and primarily sees patients who have sustained a traumatic brain injury. Dr. Patel completed medical school and residency in Texas and did a one-year fellowship in Sports NeuroTrauma at the University of Florida in Gainesville.
We were honored for our own Kristen Williams (KW) to have had the opportunity to sit down and hear about his time at Vanderbilt and his experience with treating concussion.
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KW: What is one thing about caring for sport-related concussions in athletes you would like the public to know?
MP: "I primarily see patients with traumatic brain injury- and within the spectrum of traumatic brain injury is concussion. I see a lot of athletes that have neurological issues as a part of their injury, including but not limited to headaches, dizziness, vertigo, trouble with memory, and other things like that."
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KW: How have you seen concussion care change over the course of your career?
MP: "
Throughout my training I was taught that you want to rest, rest, rest as much as possible. But now, research is suggesting otherwise. In line with consensus guidelines, I try to get people to exercise and focus on cardiovascular training, within reason. If you can get patients back to their routine sooner, it may help them feel normal as well as aid in the neurorecovery process."
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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?
MP: "Honest, I like to be honest with my patients and what their prognosis is. Empathetic, I try to listen to my patients the best I can.
Holistic, - I try to attack everything from this angle"
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| KW: What is one thing about caring for sport-related concussions in athletes you would like the public to know?
MP: "I would say it's the value of a neurologist in your care. Not everybody necessarily needs a neurologist, but if you are having a lot of symptoms that are difficult to treat, it's better if you get to a neurologist earlier rather than three to six months down the line. If you do get to a neurologist earlier for your neurological concerns and
questions, they could get you treated earlier, which could get you back out onto the field earlier as well."
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KW: Are there any other remarks or notes you may have about concussion or caring for those with sport-related concussion"
MP: "I
would say that everybody that I've interacted with at Vanderbilt Sport Concussion is very collegial and friendly. I do like the way that it's structured and that everyone works together from a teamwork approach. I think that is something unique to Vanderbilt in terms of the setup and the people that we have here it's very advantageous to our patients. I would recommend that people come here for sure."
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Fun Facts:
- He and his wife, Poonam, have been married for 2 years
- Enjoys hiking and exercise and loves sports
- Is a fan of all the Dallas sports teams (Go Rangers!)
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Concussion Resources for Parents
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Many parents are aware that their child's participation in sports may increase their risk of sustaining a concussion. There is a plethora of information on head impacts and concussions readily available for parents to reference. Here, we've taken a few key resources and helpful tools and compiled them to serve as a one stop shop for your concussion questions and concerns.
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What is a concussion?
“A concussion is a type of traumatic brain injury—or TBI—caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells.”
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| Signs of a concussion are externally visible and can be noted if an athlete:
“Can’t recall events prior to or after a hit or fall.”
“Appears dazed or stunned.”
“Forgets an instruction, is confused about an assignment or position, or is unsure of the game, score, or opponent.”
“Loses consciousness (even briefly).”
“Shows mood, behavior, or personality changes.”
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| Concussion symptoms are reported by the athlete and include:
“Headache (or pressure) in head.”
“Nausea or vomiting.”
“Balance problems, dizziness, or double or blurry vision.”
“Bothered by light or noise.”
“Confusion, concentration or memory problems.”
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What do I do if I suspect my child has a concussion?
If your child exhibits any signs or symptoms of concussion, or even if they seem fine but you suspect that they may have gotten a concussion, immediately remove them from playing and keep them out until a medical provider can perform a proper evaluation. After a suspected concussion, contact the child’s healthcare provider and try to get them seen as quickly as possible. If the athlete exhibits any of the following signs or symptoms,
call 911 or take them to the nearest emergency department right away:
“One pupil larger than the other.”
“Drowsiness or inability to wake up.”
“A headache that gets worse and does not go away.”
“Slurred speech, weakness, numbness, or decreased coordination.”
“Repeated vomiting or nausea, convulsions or seizures (shaking or twitching).”
“Unusual behavior, increased confusion, restlessness, or agitation.”
“Loss of consciousness (passed out/knocked out). Even a brief loss of consciousness should be taken seriously.”
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| Concussion Recognition Tool (CRT6)
The Concussion Recognition Tool (CRT6) is a test developed by the Concussion in Sport Group (CISG) for the identification of concussion by non-medically trained professionals. If an athlete is suspected of having suffered a concussion, the CRT6 can be used on the sideline by a parent, coach, or trainer to quickly identify potential indicators that a concussion may be present. The test comprises a checklist of visible clues, symptoms, and awareness questions. Failure to meet any of the criteria should initiate the previously mentioned sequence of actions. Best of all, the CRT6 can be freely printed out and taken to any sporting practice or event.
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Student Spotlight: Grant Rigney
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Grant Rigney is a third-year medical student at Harvard Medical School. Grant joined our team in January 2023 and is a valuable member of the V-SCoRe research team. Grant is an aspiring neurosurgeon and has a passion for concussion research. Grant has assisted with several projects and has produced two first author papers since his time with V-SCoRe. He has been a dedicated and productive member of our team, and we are excited to see what else he continues to accomplish in the future! Our own Kristen Williams (KW) sat down with Grant to learn more about his experiences with V-SCoRe.
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KW: Why did you want to get involved with V-SCoRe?
GR: "I grew up in middle Tennessee playing sports and saw the effects of concussion firsthand. I understood that if we wanted to continue playing sports in a way that is safe and allows all athletes to thrive, we had to advance our understanding of concussion triage and management. That knowledge - coupled with my love for neurosurgery and the incredible leaders and other students in the research group - made V-SCoRe a no brainer."
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KW: What are your career goals?
GR: "For as long as I can remember, I've wanted to be a neurosurgeon. The patients are some of the sickest in the hospital, and often times they can make dramatic recoveries with appropriate surgical intervention. I love this about neurosurgery and have looked forward to learning the art of neurosurgery for some time now. I plan to enter the Neurosurgery match cycle in 2024/2025 to start as a neurosurgery resident in the summer of 2025, with the long-term goal of being a practicing academic
neurosurgeon. I am currently interested in concussion/mTBI research as well as spinal oncology."
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| KW: How has V-SCoRe impacted your medical education?
GR: "Working with V-SCoRe has reminded me of the importance of approaching clinical medicine with a research mindset. Even the most common conditions and patient encounters can lead to new research questions if we listen carefully. This has pushed me to become a more critical thinker and to ask more questions. Working with V-SCoRe has also helped me refine the skills needed to answer these questions, which has been and will continue to be invaluable throughout my medical education and career"
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KW: What is the most valuable lesson you’ve learned so far working with V-SCoRe?
GR: "Research is about the patients. Yes, research is fun, and it can be easy to lose the big picture somewhere between the weeds of an analysis to the highs of getting a paper accepted for publication. However, every research question asked, analysis performed, and paper submitted represents an opportunity to make one of the hardest parts of someone else's life a little bit better. That is an absolute privilege and motivates me every day."
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Fun Facts
Grew up about an hour southeast of Vanderbilt in Tullahoma, TN.
Grew up playing the mandolin and fiddle and spent 6 years before college traveling domestically and internationally playing music with his family.
Played football, soccer, baseball, and rode motocross growing up. In high school, he swam - and in college he ran triathlons.
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Research Process
Faith Brown
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The Vanderbilt Sports Concussion Center Research (V-SCoRe) team aims to expand upon and improve the information available regarding sports-related concussions. Our research process involves choosing a meaningful topic that has room for more exploration. Often the first step is to conduct a literature review on the topic of interest to explore previously conducted research surrounding the topic. Based upon the literature review, a research question will be developed along with a hypothesis, objectives, and purpose for the study. We strive to answer questions that were left ambiguous by the literature review of previous articles from related topics. Moreover, even if a question has been asked and answered, we sometimes seek to confirm or refute their results. The cyclical process of collecting data and writing a manuscript consists of collecting, analyzing, sharing, and revising. At V-SCoRe, this process is a team effort of review and development until the research is ready to be published. Each study often involves a college student, medical student, and resident. By researching risk factors, outcomes, and management techniques for sports related concussions, we can advance the knowledge available for athletes, providers, and the scientific community. Additionally, we strive to improve recovery for those who have sustained a SRC.
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Pittsburgh Brain Bank
Olivia Shaffer
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The University of Pittsburgh established the National Sports Brain Bank (NSBB) to study the possible neurological effects of contact sports. The NSBB aims to undertake comprehensive observational studies and function as a brain donation registry for at-risk former athletes across a spectrum of sports, including football, ice hockey, soccer, boxing, and wrestling, as well as high-concussion risk activities like cheerleading, equestrian, and motocross. The focus is on those who may have experienced concussions or mild traumatic brain injuries during their athletic careers although participants do not need to have a history of concussions or current degenerative symptoms. Participants from all levels of play are encouraged to register. The new bank is also a center for long-term observational research, including longitudinal year-long studies of human medical, behavioral and mental health.
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NSBB aims to understand the potential risks associated with these sports, especially in relation to cognitive and psychiatric problems that can occur later in life. In addition, NSBB is interested in researching a neurodegenerative disease called chronic traumatic encephalopathy (CTE), which has been linked to repeated head injuries and is a substantial area of concern in contact sports. There is ongoing discussion and disagreement regarding the incidence of this disease in individuals at risk, as well as factors influencing resilience and vulnerability and the underlying pathogenic mechanisms. Presently, post-mortem tissue research is being conducted. Advancements in research on various aspects of CTE are poised to enhance understanding of this condition. The societal significance in the United States is considerable, given the prominence of sports in communities.
For participants who live nearby, autopsies will be conducted at the University of Pittsburgh and the participant's family will not be charged for the procedure. If the patient has never been admitted to The University of Pittsburgh Medical Center, there will be a charge of $1000. A professional neuropathologist will conduct the diagnostic examination by distinguishing if the brain tissue s consistent with a variety of neurodegenerative, vascular, and other disorders utilizing cutting-edge methods and consensus criteria. The NSBB will compile an official diagnostic report and send it to the family. Once the feasibility and scientific merit of the planned study has been approved, along with the completion of all required ethical permissions and material transfer agreements, de-identified tissue samples and data sets will be freely shared with qualified and interested scientists.
Thus far, the NSBB has attracted more than 80 participants who have played contact sports and have given provisional consent to donate their brains after they die. Director of the NSBB and the University of Pittsburgh’s Division of Neuropathology, Dr. Julia Kofler, would like to see that number rise in hopes of collecting as much data as possible about brain injuries and contact sports. Notably, the NSBB already has one of the nation’s largest brain collections related to ALS and Alzheimer’s disease.
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There are 3 options to register for our study. After registration, the patient will be contacted to schedule the initial over-the-phone assessment and conversation.
Website
(preferred): https://redcap.link/nsbb
E-mail: nsbb@pitt.edu
Phone: 412-692-2700 (8am - 4pm Eastern)
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Look for our next Newsletter
Spring 2024!
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If you have any questions about the VSCC Quarterly Newsletter, please reach out vscc@vumc.org
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