As the Defense Department’s center of excellence for traumatic brain injury (TBI), one of the primary goals of the Defense and Veterans Brain Injury Center (DVBIC) is to stay up-to-date on the latest in brain injury research. A team of DVBIC experts with a variety of clinical backgrounds reviewed approximately 250 abstracts from the TBI clinical research literature published in 2015, choosing the ten articles they felt advanced the field of TBI research the furthest.
Listed below and categorized by topic are the titles and summaries of these top 10 concussion research articles of 2015. Click on the links provided to access the complete abstract or article on PubMed, a service of the U.S. National Library of Medicine.
Do helmets prevent concussions? The answer isn’t as clear as you might think. This article provides the results of a new study of 138 athletes competing in similar sports with and without helmets. The study found no difference in the number or severity of concussions associated with helmet use. The study also showed that helmet use was unrelated to the symptoms experienced by athletes after a sports-related concussion. (Until further study is completed, DVBIC still recommends helmets for contact sports.)
Clinicians often struggle with the subjective nature of the diagnosis of concussion. If the injured service member or athlete chooses not to disclose their symptoms, it’s difficult, if not impossible, to make a definitive diagnosis. This article describes a new study that found that tablet-based technology can provide a more sensitive and objective diagnosis of some functional deficits typically associated with concussion.
A study of nearly 1,000 National Guardsmen found that one year after returning from deployment, 15 percent reported that they suffered a TBI while serving in Iraq, but hadn’t reported the TBI in theater. This article discusses the study, which found that those who reported TBI one year following their return were more likely to have posttraumatic stress disorder and other non-specific physical complaints. The inconsistency in self-reporting and the potential impact on long-term function highlights the need for advances in the accurate, objective measurement of concussion.
With recent heightened concerns about the long-term effects of a concussion, there’s a focus on conservative acute care of the concussed individual. However, recent studies discussed in this article suggest that while removal from activities that might risk a repeat concussion for a period of time is certainly important, a progressive return to activity protocol may be equally important. In fact, prolonged restriction on activity can actually contribute to the development and persistence of post-concussive symptoms.
DVBIC developed a resource to help providers understand progressive return to activity: “Progressive Return to Activity Following Acute Concussion/Mild TBI Clinical Recommendation”
Is it possible to get too much rest after a concussion? This article describes the study that found that among grade school to college-aged individuals, strict bed rest for five days following a concussion resulted in more daily post-concussive symptoms and a slower recovery from post-concussive symptoms compared with those who had a step-wise return to activity after just one to two days of rest.
In the acute management of a concussion, too much bed rest may slow recovery, but not enough sleep over the long term may also be a problem. Many people think of post-concussion syndrome as involving behavioral problems such as short tempers, or lack of emotional control, but a recent study of 374 patients with concussion, described in this article, found that sleep problems may be a very important but often overlooked cause of those behavioral problems. In fact, sleep problems can negatively impact long-term functional and social outcomes. As a result, clinicians should be sure that those still experiencing behavioral or cognitive problems weeks or months after their concussion are getting enough sleep.
DVBIC published this resource to help providers manage the sleep of their concussed patients: “Management of Sleep Disturbances Following Concussion/Mild TBI Clinical Suite”
Chronic traumatic encephalopathy (CTE) is often highlighted in the media over concerns that it’s associated with repeated head injuries, as might be experienced by playing football. However, the frequency with which CTE occurs may be exaggerated by the numerous publications from one particular institution, as well as a recent highly-publicized movie. This article, which provides a systematic review of all available peer-reviewed literature, suggests that only 153 confirmed and unique cases of CTE have been described, and that some cases have been reported multiple times, possibly inflating earlier estimates of the incidence of CTE.
2/5/2016 Update: Editor's note: The study's authors have made corrections to the original article, “Chronic Traumatic Encephalopathy in Contact Sports”.
DVBIC hosted a webinar on this topic earlier this year: CTE point/counterpoint webinar
This article describes a study that used the specialized technique of diffusion tensor imaging conducted by a renowned research team, which found that blast-related concussion causes measureable injury to the white matter of the brain. This injury correlates with behavioral and memory problems, as well as balance difficulties. Furthermore, the brain damage wasn’t observable with conventional MRI.
Learn more about neuroimaging with this DVBIC resource: “Neuroimaging Following Mild TBI in the Non-Deployed Setting Clinical Recommendation”
This article describes a study in which researchers using diffusion tensor imaging found post-concussive white matter damage to the brain, with changes lasting more than a year after the injury. Most notably, the research found a connection between greater post-concussive symptoms and greater evidence of structural changes in the brain. In other words, patients who experience long-lasting post-concussive symptoms may have the structural changes to prove it.
Studies published in 2014 clearly show that white matter damage is often associated with post-concussion syndrome. This article describes a study that also shows that those individuals with lower cognitive reserve, which the authors quantified by assessing intelligence, educational level and occupational skill level, are at greater risk for prolonged post-concussion syndrome.
Check out this DVBIC provider resource on cognitive rehabilitation: “PDF: PDF Cognitive Rehabilitation for Mild TBI Clinical Recommendations”