In October, the world’s most comprehensive concussion study received a new infusion of $22.5 million to continue its work examining the impact of head injuries on student athletes. That’s huge news for the Medical College of Wisconsin, one of four educational institutions (along with Indiana University’s School of Medicine, the University of Michigan and the Uniformed Services University of the Health Sciences) leading the NCAA-DOD Concussion Assessment, Research and Education Consortium.
Better known as the CARE Consortium, the study is funded by the National Collegiate Athletic Association (NCAA) and the U.S. Department of Defense (DOD). It began in 2014 with a $30 million grant and the twin goals of understanding how concussions affect the brain and identifying ways to improve diagnosis, treatment and prevention. So far, the CARE Consortium has collected data on more than 39,000 student athletes and cadets at 30 colleges, universities and military service academies—including the University of Wisconsin. More than 3,300 of the study’s participants have experienced concussions.
“It was really our work over the last 20 years that put us in a position to compete for and lead the CARE Consortium project,” says Michael McCrea, professor of neurosurgery and co-director of the Center for Neurotrauma Research at the Medical College of Wisconsin (MCW), who is one of the study’s leaders. McCrea and his MCW team focus on head impact sensor technologies, advanced neuroimaging and biological markers that include detailed genetic testing. The college’s participation in such a monumental project is indicative of Wisconsin’s status as a leader in concussion research that is changing not only how concussions are diagnosed and treated, but also the way in which people perceive brain injuries.
“Wisconsin is known for collaborative, interprofessional concussion research,” says Traci Snedden, assistant professor and pediatric nurse practitioner at the UW-Madison School of Nursing. Snedden’s recent work links concussions in students to academic struggles. “That’s how change is going to happen: by doing research collaboratively.” Snedden (along with several other researchers around the state) is among those whose diverse body of work provides national insight into the ever-evolving science of concussions, which commonly occur not only in football but also in such winter sports as basketball, wrestling and ice hockey. Those researchers also include Alison Brooks—associate professor in UW-Madison’s Department of Orthopedics and principal investigator at the CARE Consortium’s Madison site—and Brian Stemper, associate professor of biomedical engineering at Marquette University and MCW.
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Increasing Public Awareness
McCrea, for one, has been at this a long time. In the late 1990s, he and renowned University of North Carolina sports medicine researcher Kevin Guskiewicz co-led the NCAA’s first concussion study, which, though limited to male student athletes, was the largest of its kind at the time. “Back in those days, we were relying on a symptoms checklist, and the athletes self-reported,” McCrea says. “Fast-forward over the past 20 years, and we now have the ability to better understand the effects of this injury on the brain and how long it takes the brain to recover.”
Indeed, concussion awareness among medical professionals and the general public has come a long way from what might as well be considered the dark ages. That was before the term “Chronic Traumatic Encephalopathy,” a brain condition associated with repeated blows to the head, better known as CTE, became a common part of the vernacular. National Football League (NFL) players such as former Wisconsin Badgers linebacker Chris Borland began retiring at the peak of their careers, fearing long-term brain damage, and parents stopped letting their young kids play tackle football. CTE cannot be detected until death and has been found in several deceased NFL players. The Medical College of Wisconsin will co-lead a study on the potential long-term neurologic health consequences of concussions and sub-concussive injuries sustained by as many as 2,500 former NFL players. McCrea is co-principal investigator on the study, which was announced on Thursday, Nov. 15.
“[The medical community has] evolved from doing nothing about concussions to a very awkward and misguided period of ‘cocoon therapy,’ where people were advising athletes to go into a dark room and observe total rest for an extended period of time. We soon realized that did more harm than good,” McCrea says. “Then, the pendulum swung back, and we’re now studying approaches toward active rehabilitation, meaning that, after an athlete has observed a brief period of rest to let symptoms improve, we introduce low-level exercise that we know is good for brain recovery but also really good for the athlete’s mental health.”
McCrea, who recently was elected president of the Society for Clinical Neuropsychology, also spearheads MCW’s Project Head to Head II, an ongoing study of sports-related concussions in high school and college athletes in Southeastern Wisconsin. Additionally, he oversees a study funded by the NFL to determine the role of active rehabilitation strategies in concussion management.
Return to Play or Return to Learn?
Snedden’s work has made headlines for linking concussions to increased academic struggles. Her research indicates that concussed college students (not just athletes) at the University of Wisconsin experience shorter attention spans, more time-management troubles and more difficulty taking notes than students with other injuries, such as broken bones and torn ligaments. She also recently conducted a similar study with high school students (mostly athletes) in the Milwaukee and Madison areas.
“There has been more focus on return to play than return to learn,” Snedden says. “Thankfully, we’re gaining some progress in placing attention on the return-to-learn component after this type of injury.” As evidence, Snedden notes that some high schools in Wisconsin have enlisted concussion-management teams to help students recovering from a head injury better navigate the return-to-learn process. Stemper, meanwhile, is the lead author of a recent study that concludes a football player hit in the head might suffer a concussion not as a result of that single impact but based on the number and severity of hits his head sustained in the days, weeks and months prior to the concussion. His findings provide further support for limiting head-impact exposure during practices and games.
Collectively, the research conducted by Stemper, Snedden, McCrea and others is helping steer the local and national concussion discussion. “When we first got into this work, there were high school athletes rendered unconscious who were returning to play during the same game. Those days are gone,” McCrea says about the combined impact of collaborative research and the subsequent boost in overall concussion awareness among players, coaches, parents and athletic administrators. “In 15 years, return to play has gone from 15 minutes to 15 days.” Meanwhile, “the science continues to grow, and it’s going to get more complex,” Snedden adds. “But every single day, we are learning.”
