Cross Over Studies (Sports / Military / Everyday Life)

One of the first projects undertaken by the Seeing Stars Foundation is to fund a multi-center research project to test a concussion specific neurological exam which has been designed by members of our medical board. Although the military currently uses the Military Acute Concussion Evaluation (MACE) which consists of standardized testing of cognition, neurologic functions including balance, and a symptom screen. And many professional and amateur sports organizations use the Sideline Concussion Assessment Tool (SCAT 3). Neither has been validated. A validated neurological exam can then be applied to the sideline evaluation of concussed athletes and can be administered in the battlefield to a concussed soldier. It can also be used serially to return athletes and soldiers to play and battle.


Other possible crossover applications would include evidence based studies into the treatment of post traumatic headache, depression, vestibular dysfunction and longitudinal diffusion tensor magnetic resonance imaging (MRI). Initial Diffusion Tensor Imaging and Susceptibility Weighted Imaging studies have already shown evidence of nerve damage in 30-40 percent of service members who are symptomatic from a concussion. The military has begun initial studies where an image of the soldier’s brain is taken prior to deployment to create a baseline that can then be compared with an image after combat.


Another one of the initial projects of The Seeing Stars Foundation is the funding of a longitudinal diffusion tensor magnetic resonance imaging study, where an athlete is screened prior to the season and then followed if he or she experiences a concussion. This type of imaging is essentially objective, using numeric values which appear to change over time as the brain recovers. Our medical advisory board sees DTI MRI as “The” future objective measure for diagnosis and recovery from concussion. Along with the Department of Defense they also see parallels for application in the battlefield.


Other Facts on military concussion.
Individuals who sustain a concussion often do not seek out medical attention. The reasons for this are that the symptoms of concussion quickly subside in most subjects within seconds or minutes after the injury. Also it is the culture among service members and athletes to ignore signs and symptoms of concussion and return to the fight or play as quickly as possible. Thus, caregivers and coaches must be vigilant for the signs and symptoms of TBI in any service member or athlete who may have sustained a blow to the head.


In 2011 the DoD instituted a requirement that all service members exposed to a blast event (within 50 meters), or who were inside a vehicle or building exposed to a blast, must be removed from combat for at least 24 hours and be medically evaluated prior to return to duty. Likewise, the National Football League instituted rigid new requirements that state, in part: "Once removed for the duration of a practice or game, the player should not be considered for return-to-football activities until he is fully asymptomatic, both at rest and after exertion, has a normal neurological examination, normal neuropsychological testing, and has been cleared to return by both his team physician(s) and the independent neurological consultant." These new policies were instituted in direct response to the culture of the service members and players wanting to return to combat/play too soon and not being forthcoming about their symptoms.


Those individuals who remain symptomatic 24-48 hours after the injury are often referred for further testing. In-theater service members will often be referred to a concussion care center and will likely have more detailed cognitive testing with the Automated Neuropsychological Assessment Metric (ANAM). Post-injury test results can be compared with pre-deployment tests, and serial studies can be done to follow recovery from the cognitive deficits sustained from the concussion. Increasingly high school, collegiate and professional sports teams are obtaining pre-season neurocognitive baseline testing so that cognitive deficits can be detected more easily after a concussion.


Brain injury symptoms include severe headaches, memory problems, impulsivity or impaired judgment, and even depression. Taken as a group, these symptoms are often called post-concussive syndrome. At least 253,000 American servicemen and women were diagnosed with brain injuries in the last twelve years.


Study’s Results Show Bad News For Brain Injury Victims. The new study looked at symptoms of post-concussive syndrome over a period of time. Researchers evaluated veterans with brain injuries during the first four years after a brain injury and then again in the next four years after that. Over the course of eight years, the researchers found that symptoms still had not diminished. Almost 50 percent of the surveyed veterans reported continuing headaches. Forty-six percent said  that their headaches were still “severe” up to four years after an injury. Fast forward another four years and the numbers were even worse: 51 percent of respondents said that they suffered from severe headaches.


Researchers also said that a similar pattern appeared in other brain injury symptom categories like depression, impulsive decision-making, and coordination. Because brain injuries can be cumulative, veterans who suffered multiple concussions also seemed to experience even worse symptoms. Although the study concludes worsening symptoms over time, some experts believe that most if not the vast majority of the TBI’s in the study were not handled/managed correctly.  If you go back eight years the treatment of this injury was way wrong, and often never allowed the brain to fully heal. Concussions/TBI’s are often forgot after the fact because they are invisible to everyone, except for the person suffering from them.


This study really hammers home the need for proper management, remember that the elephant in the room is not the injury, rather the mismanagement of the injury.  It is the opinion of some neurologists that in 2004 concussions were mismanaged and now we are seeing some results of this.  Moreover, this should justify removing anyone with a TBI/concussion from activity until fully recovered; sports, military or life in general.



About The Author

Dr. Francis (Frank) Conidi

Dr. Conidi is the Chairman for Seeing Stars Foundation and is currently the Director of the Florida Center for Headache and Sports Neurology, a tertiary headache center which specializes in the treatment Sports Related neurological disorders with an emphasis on sports related mild traumatic brain injury as well as refractory headache patients and patients with facial pain. He is the team neurologist for the NHL’s Florida Panthers and a member of their medical team; as well as consulting neurologist for the Miami Dolphins and NY Mets (major and minor league teams).