Posts tagged concussions
Articles and news from the latest research reports.
Study finds cognitive performance can be improved in teens months,years after traumatic brain injury
Traumatic brain injuries from sports, recreational activities, falls or car accidents are the leading cause of death and disability in children and adolescents. While previously it was believed that the window for brain recovery was at most one year after injury, new research from the Center for BrainHealth at The University of Texas at Dallas published online today in the open-access journal Frontiers in Neurology shows cognitive performance can be improved to significant degrees months, and even years, after injury, given targeted brain training.
"The after-effects of concussions and more severe brain injuries can be very different and more detrimental to a developing child or adolescent brain than an adult brain," said Dr. Lori Cook, study author and director of the Center for BrainHealth’s pediatric brain injury programs. "While the brain undergoes spontaneous recovery in the immediate days, weeks, and months following a brain injury, cognitive deficits may continue to evolve months to years after the initial brain insult when the brain is called upon to perform higher-order reasoning and critical thinking tasks."
Twenty adolescents, ages 12-20 who experienced a traumatic brain injury at least six months prior to participating in the research and were demonstrating gist reasoning deficits, or the inability to “get the essence” from dense information, were enrolled in the study. The participants were randomized into two different cognitive training groups – strategy-based gist reasoning training versus fact-based memory training.
Participants completed eight, 45-minute sessions over a one-month period. Researchers compared the effects of the two forms of training on the ability to abstract meaning and recall facts. Testing included pre- and post-training assessments, in which adolescents were asked to read several texts and then craft a high-level summary, drawing upon inferences to transform ideas into novel, generalized statements, and recall important facts.
After training, only the gist-reasoning group showed significant improvement in the ability to abstract meanings – a foundational cognitive skill to everyday life functionality. Additionally, the gist-reasoning-trained group showed significant generalized gains to untrained areas including executive functions of working memory (i.e., holding information in mind for use – such as performing mental addition or subtraction ) and inhibition (i.e., filtering out irrelevant information). The gist-reasoning training group also demonstrated increased memory for facts, even though this skill was not specifically targeted in training.
"These preliminary results are promising in that higher-order cognitive training that focuses on ‘big picture’ thinking improves cognitive performance in ways that matter to everyday life success," said Dr. Cook. "What we found was that training higher-order cognitive skills can have a positive impact on untrained key executive functions as well as lower-level, but also important, processes such as straightforward memory, which is used to remember details. While the study sample was small and a larger trial is needed, the real-life application of this training program is especially important for adolescents who are at a very challenging life-stage when they face major academic and social complexities. These cognitive challenges require reasoning, filtering, focusing, planning, self-regulation, activity management and combating ‘information overload,’ which is one of the chief complaints that teens with concussions express."
This research advances best practices by implicating changes to common treatment schedules for traumatic brain injury and concussion. The ability to achieve cognitive gains through a brain training treatment regimen at chronic stages of brain injury (6 months or longer) supports the need to monitor brain recovery annually and offer treatment when deficits persist or emerge later.
"Brain injuries require routine follow-up monitoring. We need to make sure that optimized brain recovery continues to support later cognitive milestones, and that is especially true in the case of adolescents," said Dr. Sandra Bond Chapman, study author, founder and chief director of the Center for BrainHealth and Dee Wyly Distinguished University Chair at The University of Texas at Dallas. "What’s promising is that no matter the severity of the injury or the amount of time since injury, brain performance improved when teens were taught how to strategically process incoming information in a meaningful way, instead of just focusing on rote memorization."
(Source: brainhealth.utdallas.edu)
(Image caption: Uncinate fasiculus, an important tract with the greatest concentration of progesterone receptors, show greater injury in males than females after mild traumatic brain injury (mTBI). (a) Axial and (b) coronal images show regions of decreased fractional anisotropy in male patients with mTBI relative to female mTBI patients, involving the uncinate fasiculus (red) bilaterally.)
Gender May Contribute to Recovery Time After Concussion
A study of concussion patients using diffusion tensor imaging (DTI) found that males took longer to recover after concussion than females did. Results of the study, which show that DTI can be used as a bias-free way to predict concussion outcome, are published online in the journal Radiology.
Each year, more than 17 million Americans suffer a mild traumatic brain injury (mTBI), more commonly known as a concussion, of which approximately 15 percent suffer persistent symptoms beyond three months.
Assessing outcomes and recovery time after concussion can be very subjective. Typically, physicians must rely on patient cooperation to assess injury severity.
"MRI and CT brain images of concussion patients are often normal," said Saeed Fakhran, M.D., assistant professor of neuroradiology at the University of Pittsburgh School of Medicine. "Diffusion tensor imaging is the first imaging technique that shows abnormalities associated with concussion, because it is able to see white matter tracts at a microscopic level."
DTI is an advanced form of MRI that allows researchers to assess microscopic changes in the brain’s white matter. The brain’s white matter is composed of millions of nerve fibers called axons that act like communication cables connecting various regions of the brain. DTI produces a measurement, called fractional anisotropy (FA), of the movement of water molecules along axons. In healthy white matter, the direction of water movement is fairly uniform and measures high in FA. When water movement is more random, FA values decrease. Abnormally low FA is associated with cognitive impairment in patients with brain injuries.
The research team examined the medical records and imaging results of 69 patients diagnosed with mTBI between 2006 and 2013, including 47 males and 22 females, and 21 controls consisting of 10 males and 11 females (median age of males: 17; median age of females: 16). Of the 47 males with mTBI, 32 (68 percent) were injured while playing a sport, as were 10 of the 22 females (45 percent).
All patients underwent the same evaluation, including a computerized neurocognitive test and DTI of the brain. The DTI scans of the mTBI patients revealed abnormalities within the uncinate fasciculi (UF), a white matter tract that connects the frontal and temporal lobes of the brain. Although its exact role is controversial, the UF tract is believed to allow temporal lobe-based memory associations to modify behavior though interactions with another area of the brain.
The DTI scans revealed that compared to the female mTBI patients, the male mTBI patients had significantly decreased UF FA values.
"In the future, we would like to look at the issue of gender and concussions more in depth to determine who does better and why," Dr. Fakhran said.
A statistical analysis of the data revealed that UF FA value was a stronger predictor of recovery time than initial symptom severity based on neurocognitive testing. The most substantial risk factor for a recovery time longer than three months was decreased UF FA. Male gender also directly correlated with increased recovery time.
"The potential of DTI and UF FA to predict outcome after concussion has great clinical impact," Dr. Fakhran said. "Currently, we are heavily reliant on patient reporting, and patients may have ulterior motives, such as wanting to get back to play. But you can’t trick an MR scanner."
The average time to symptom recovery for all concussion patients was 54 days. However, compared to the female patients who recovered in an average of 26.3 days, recovery was significantly longer for the male patients (an average of 66.9 days), irrespective of initial symptom severity.
"Male gender and UF FA values are independent risk factors for persistent post-concussion symptoms after three months and stronger predictors of time to recovery than initial symptom severity or neurocognitive test results," Dr. Fakhran said.
He said results of the study indicate a potential role for UF FA values in triaging concussion patients in the future.
"There’s prognostic value in DTI for both children participating in sports as well as for professional athletes," he said. "Lower FA values in the uncinate fasciculi could offer a metric for evaluating the severity of mild traumatic brain injuries and predicting clinical outcome. We’re not at the point where DTI can provide individual prognoses yet, but that’s the hope and goal."
MRI Pinpoints Region of Brain Injury in Some Concussion Patients
Researchers using information provided by a magnetic resonance imaging (MRI) technique have identified regional white matter damage in the brains of people who experience chronic dizziness and other symptoms after concussion.
The findings suggest that information provided by MRI can speed the onset of effective treatments for concussion patients. The results of this research are published online in the journal Radiology.
Concussions, also known as mild traumatic brain injury (mTBI), affect between 1.8 and 3.8 million individuals in the United States annually.
How Well Do Football Helmets Protect Players from Concussions?
A new study finds that football helmets currently used on the field may do little to protect against hits to the side of the head, or rotational force, an often dangerous source of brain injury and encephalopathy. The study released today will be presented at the American Academy of Neurology’s 66th Annual Meeting in Philadelphia, April 26 to May 3, 2014.
"Protection against concussion and complications of brain injury is especially important for young players, including elementary and middle school, high school and college athletes, whose still-developing brains are more susceptible to the lasting effects of trauma," said study co- author Frank Conidi, MD, DO, MS, director of the Florida Center for Headache and Sports Neurology and Assistant Clinical Professor of Neurology at Florida State University College of Medicine in Port Saint Lucie, Fla. Conidi is also the vice chair of the American Academy of Neurology’s Sports Neurology Section.
For the study, researchers modified the standard drop test system, approved by the National Operating Committee on Standards for Athletic Equipment, that tests impacts and helmet safety. The researchers used a crash test dummy head and neck to simulate impact. Sensors were also placed in the dummy’s head to measure linear and rotational responses to repeated 12 mile-per-hour impacts. The scientists conducted 330 tests to measure how well 10 popular football helmet designs protected against traumatic brain injury, including: Adams a2000, Rawlings Quantum, Riddell 360, Riddell Revolution, Riddell Revolution Speed, Riddell VSR4, Schutt Air Advantage, Schutt DNA Pro+, Xenith X1 and Xenith X2.
The study found that football helmets on average reduced the risk of traumatic brain injury by only 20 percent compared to not wearing a helmet. Of the 10 helmet brands tested, the Adams a2000 provided the best protection against concussion and the Schutt Air Advantage the worst. Overall, the Riddell 360 provided the most protection against closed head injury and the Adams a2000 the least, despite rating the best against concussion.
"Alarmingly, those that offered the least protection are among the most popular on the field," said Conidi. "Biomechanics researchers have long understood that rotational forces, not linear forces, are responsible for serious brain damage including concussion, brain injury complications and brain bleeds. Yet generations of football and other sports participants have been under the assumption that their brains are protected by their investment in headwear protection."
The study found that football helmets provided protection from linear impacts, or those leading to bruising and skull fracture. Compared to tests using dummies with no helmets, leading football helmets reduced the risk of skull fracture by 60 to 70 percent and reduced the risk of focal brain tissue bruising by 70 to 80 percent.
The study was supported by BRAINS, Inc., a research and development company based in San Antonio, Fla., focused on biomechanics of traumatic brain injury.
Groundbreaking Research Explores Link Between Traumatic Brain Injury and Sleep
It has long been believed that a person with a concussion should stay awake or not sleep for more than a few hours at a time.
But there appears to be no medical evidence to support that idea, according to a study regarding the relationship between traumatic brain injury, also known as TBI, and sleepiness conducted by scientists at Barrow Neurological Institute at Phoenix Children’s Hospital and the University of Arizona College of Medicine – Phoenix.
"This translational research study lays the foundation for understanding the immediate impact of brain injury on a person’s physiology. In this case, substantial post-traumatic sleep occurred regardless of injury timing or severity," said Jonathan Lifshitz, director of the Translational Neurotrauma Program at Barrow Neurological Institute at Phoenix Children’s Hospital and an associate professor at the UA College of Medicine – Phoenix. "These studies explore sleep as an immediate response to TBI."
Traumatic brain injury is a major cause of death and disability throughout the world with little pharmacological treatment for the individuals who suffer from lifelong problems associated with TBI. Clinical studies have provided evidence to support the claim that brain injury contributes to chronic sleep disturbances as well as excessive daytime sleepiness. Clinical observations have reported excessive sleepiness immediately following traumatic brain injury. However; there is a lack of experimental evidence to support or refute the benefit of sleep following a brain injury.
"We know that some individuals after a traumatic brain injury become excessively sleepy and some cannot sleep at all. It is not well understood why this occurs as mechanisms of injury, and locations of injury are not always consistent between clinical phenotypes of normal sleep, hypersomnia and insomnia," said Matthew Troester, a neurologist and sleep specialist at Phoenix Children’s Hospital and a clinical assistant professor at the UA College of Medicine – Phoenix.
Lifshiz and his associates are breaking new ground with descriptions of sleep in the acute – or immediately after injury – state, where little is known clinically, Troester added.
"They demonstrate that the subjects slept immediately and similarly post-injury no matter the severity of the injury or time of day the injury occurred. This tells us that the brain is reacting to the injury in a very specific manner – not something we always see clinically – and, ultimately, this may help us better understand what the role of sleep is in brain injury" such as being restorative, protective or merely a consequence of the injury, he said. "It is an exciting beginning."
This initial study is phase one of the Post-Traumatic Sleep Study. Phase two is in the works. The research will look to provide medical evidence for sleeping after a concussion.
(Source: uanews.org)
Head injuries triple long-term risk of early death
Survivors of traumatic brain injuries (TBI) are three times more likely to die prematurely than the general population, often from suicide or fatal injuries, finds an Oxford University-led study.
A TBI is a blow to the head that leads to a skull fracture, internal bleeding, loss of consciousness for longer than an hour or a combination of these symptoms. Michael Schumacher’s recent skiing injury is an example of a TBI. Concussions, sometimes called mild TBIs, do not present with these symptoms and were analysed separately in this study.
Researchers examined Swedish medical records going back 41 years covering 218,300 TBI survivors, 150,513 siblings of TBI survivors and over two million control cases matched by sex and age from the general population. The work was carried out by researchers at Oxford University and the Karolinska Institute in Stockholm.
'We found that people who survive six months after TBI remain three times more likely to die prematurely than the control population and 2.6 times more likely to die than unaffected siblings,' said study leader Dr Seena Fazel, a Wellcome Trust Senior Research Fellow in Oxford University's Department of Psychiatry. 'Looking at siblings who did not suffer TBIs allows us to control for genetic factors and early upbringing, so it is striking to see that the effect remains strong even after controlling for these.'
The results, published in the journal JAMA Psychiatry, show that TBI survivors who also have a history of substance abuse or psychiatric disorders are at highest risk of premature death. Premature deaths were defined as before age 56. The main causes of premature death in TBI survivors are suicide and fatal injuries such as car accidents and falls.
'TBI survivors are more than twice as likely to kill themselves as unaffected siblings, many of whom were diagnosed with psychiatric disorders after their TBI,' said Dr Fazel. 'Current guidelines do not recommend assessments of mental health or suicide risk in TBI patients, instead focusing on short-term survival. Looking at these findings, it may make more sense to treat some TBI patients as suffering from a chronic problem requiring longer term management just like epilepsy or diabetes. TBI survivors should be monitored carefully for signs of depression, substance abuse and other psychiatric disorders, which are all treatable conditions.'
The exact reasons for the increased risk of premature death are unknown but may involve damage to the parts of the brain responsible for judgement, decision making and risk taking. TBI survivors are three times more likely to die from fatal injuries which may be a result of impaired judgement or reactions.
'This study highlights the important and as yet unanswered question of why TBI survivors are more likely to die young, but it may be that serious brain trauma has lasting effects on people's judgement,' suggests Dr Fazel. 'People who have survived the acute effects of TBI should be more informed about these risks and how to reduce their impact.'
'When treating traumatic brain injuries focus is placed on immediate treatment and recovery of patients,' says Dr John Williams, Head of Neuroscience and Mental Health at the Wellcome Trust. 'This new finding offers important insight into the longer-term impact of TBIs on the brain and their effect on survival later in life. We hope that further research into understanding which parts of the brain are responsible will help improve future management programmes and reduce the potential for premature death.'
Even relatively minor brain injuries, concussions, had a significant impact on early mortality. People with concussion were found to be twice as likely to die prematurely as the control population, with suicide and fatal injuries as the main causes of death. This raises issues surrounding concussions in a wide range of sports, from American football, rugby and soccer to baseball and cricket.
(Source: ox.ac.uk)
Veterans’ Head Injury Examined
Roadside bombs and other blasts have made head injury the “signature wound” of the Iraq and Afghanistan conflicts. Most combat veterans recover from mild traumatic brain injury, also known as concussion, but a small minority experience significant and long-term side effects.
Now, researchers at Albert Einstein College of Medicine of Yeshiva University, in cooperation with Resurrecting Lives Foundation, are investigating the effect of repeated combat-related blast exposures on the brains of veterans with the goal of improving diagnostics and treatment.
Mild traumatic brain injury can cause problems with cognition, concentration, memory and emotional control as well as post-traumatic stress disorder (PTSD). Einstein scientists are using advanced MRI technology and psychological tests to investigate the structural and biological impact of repeated head injury on the brain and to assess how these injuries affect cognitive function.
"Right now, doctors diagnose concussion purely on the basis of someone’s symptoms," said Michael Lipton, M.D., Ph.D., associate director of Einstein’s Gruss Magnetic Resonance Research Center. "We hope that our research will lead to a more scientifically valid diagnostic technique—one that uses imaging to not only detect the underlying brain injury but reveal its severity. Such a technique could also objectively evaluate therapies aimed at healing the brain injuries responsible for concussions." Dr. Lipton is also associate professor of radiology, of psychiatry and behavioral sciences and of neuroscience at Einstein and medical director of MRI services at Montefiore Medical Center, the University Hospital for Einstein.
The Einstein researchers are studying 20 veterans from Ohio and Michigan who were deployed in Iraq and Afghanistan and have exhibited symptoms of repeated concussion. Twenty of the veterans’ siblings or cousins without concussion are acting as controls. The researchers are using an advanced MRI-based imaging technique called diffusion tensor imaging (DTI) to identify injured brain areas.
DTI “sees” the movement of water molecules within and along axons, the nerve fibers that constitute the brain’s white matter. This imaging technique allows researchers to measure the uniformity of water movement (called fractional anisotropy, or FA) throughout the brain. Abnormally low FA within white matter indicates axon damage and has previously been associated with cognitive impairment in patients with traumatic brain injury. (The researchers also use DTI in an ongoing study of amateur soccer players to assess possible brain injury from repeatedly heading soccer balls.)
The final group of veterans is scheduled to visit Einstein for testing in February 2014. Preliminary results should be available later this year.
Are concussions related to Alzheimer’s disease?
A new study suggests that a history of concussion involving at least a momentary loss of consciousness may be related to the buildup of Alzheimer’s-associated plaques in the brain. The research is published in the December 26, 2013, online issue of Neurology®, the medical journal of the American Academy of Neurology.
"Interestingly, in people with a history of concussion, a difference in the amount of brain plaques was found only in those with memory and thinking problems, not in those who were cognitively normal," said study author Michelle Mielke, PhD, with Mayo Clinic in Rochester, Minn.
For the study, people from Olmsted County in Minnesota were given brain scans; these included 448 people without any signs of memory problems and 141 people with memory and thinking problems called mild cognitive impairment. Participants, who were all age 70 or older, were also asked about whether they had ever experienced a brain injury that involved any loss of consciousness or memory.
Of the 448 people without any thinking or memory problems, 17 percent reported a brain injury and 18 percent of the 141 with memory and thinking difficulties reported a concussion or head trauma.
The study found no difference in any brain scan measures among the people without memory and thinking impairments, whether or not they had head trauma. However, people with memory and thinking impairments and a history of head trauma had levels of amyloid plaques an average of 18 percent higher than those with no head trauma history.
"Our results add merit to the idea that concussion and Alzheimer’s disease brain pathology may be related," said Mielke. "However, the fact that we did not find a relationship in those without memory and thinking problems suggests that any association between head trauma and amyloid is complex."
Brain Still Injured from Concussion After Symptoms Fade
After a mild concussion, special brain scans show evidence of brain abnormalities four months later, when symptoms from the concussion have mostly dissipated, according to research published in the November 20, 2013, online issue of Neurology®, the medical journal of the American Academy of Neurology.
“These results suggest that there are potentially two different modes of recovery for concussion, with the memory, thinking and behavioral symptoms improving more quickly than the physiological injuries in the brain,” said study author Andrew R. Mayer, PhD, of the Mind Research Network and University of New Mexico School of Medicine in Albuquerque.
Mayer further suggests that healing from concussions may be similar to other body ailments such as recovering from a burn. “During recovery, reported symptoms like pain are greatly reduced before the body is finished healing, when the tissue scabs. These finding may have important implications about when it is truly safe to resume physical activities that could produce a second concussion, potentially further injuring an already vulnerable brain.”
Mayer noted that standard brain scans such as CT or MRI would not pick up on these subtle changes in the brain. “Unfortunately, this can lead to the common misperception that any persistent symptoms are psychological.”
The study compared 50 people who had suffered a mild concussion to 50 healthy people of similar age and education. All the participants had tests of their memory and thinking skills and other symptoms such as anxiety and depression two weeks after the concussion, as well as brain scans. Four months after the concussion, 26 of the patients and 26 controls repeated the tests and scans.
The study found that two weeks after the injury the people who had concussions had more self-reported problems with memory and thinking skills, physical problems such as headaches and dizziness, and emotional problems such as depression and anxiety than people who had not had concussions. By four months after the injury, the symptoms were significantly reduced by up to 27 percent.
The people who had concussions also had evidence of abnormalities in the gray matter in the frontal cortex area of both sides of the brain, based on the diffusion tensor imaging scans. The increase equated to about 10 percent compared to the healthy people in the study. These abnormalities were still apparent four months after the concussion. In contrast, there was no evidence of cellular loss on scans.
Mayer said possible explanations for the brain abnormalities could be cytotoxic edema, which results from changes in where fluids are located in and around brain cells, or reactive gliosis, which is the change in glial cells’ shape in response to damage to the central nervous system.
Traumatic Brain Injury Research Advances with $18.8M NIH Award
The National Institutes of Health is awarding $18.8 million over five years to support worldwide research on concussion and traumatic brain injury.
The NIH award, part of one of the largest international research collaborations ever coordinated by funding agencies, will be administered through UC San Francisco.
The award supports a team of U.S. researchers at more than 20 institutions throughout the country who are participating in the International Traumatic Brain Injury (InTBIR) Initiative, a collaborative effort of the European Commission, the Canadian Institutes of Health Research (CIHR), the National Institutes of Health (NIH) and the U.S. Department of Defense (DOD).
Although the potential long-term harms due to concussions and blows to the head have gained more attention recently – due in part to media coverage of the experiences of athletes and of soldiers returning from the Middle East – traumatic brain injuries, or TBI, that results from automobile crashes or other common accidents impacts many more people.
Many of those who are affected by TBI are never diagnosed, according to UCSF neurosurgeon Geoffrey Manley, MD, PhD, a principal investigator for the grant who will serve as the U.S. research team’s primary liaison to the NIH, and the chief of neurosurgery at the UCSF-affiliated San Francisco General Hospital, a Level-1 trauma center. SFGH was the first medical center in the nation to achieve certification from the Joint Commission for the treatment of TBI.
The U.S. Centers for Disease Control and Prevention estimates that 2 percent of the U.S. population now lives with TBI-caused disabilities, at an annual cost of about $77 billion.
“Each year in the United States, at least 1.7 million people seek medical attention for TBI,” Manley said. “It is a contributing factor in a third of all injury-related deaths.”
In the work funded by the NIH grant – which also is supported by contributions from the private sector and from the nonprofit One Mind for Research – the researchers aim to refine and improve diagnosis and treatment of TBI, which often has insidious health effects, but which frequently is undiagnosed, misdiagnosed, inadequately understood and undertreated, according to Manley.
New Approach to Lead to Patient-Specific Treatments
“After three decades of failed clinical trials, a new approach is needed,” Manley said. “We expect that our approach will permit researchers to better characterize and stratify patients, will allow meaningful comparisons of treatments and outcomes, and will improve the next generation of clinical trials. The work will advance our understanding of TBI and lead to more effective, patient-specific treatments.”
Since 2009, Manley and Pratik Mukherjee, MD, PhD, a professor of radiology and biomedical imaging at UCSF, have helped lay the groundwork for the continuing TBI research by leading the NIH-funded TRACK-TBI project, through which they and their research collaborators have demonstrated the value of gathering common data across research sites, including a standardized approach to imaging, clinical data, bio-specimens, and tracking outcomes.
Already, TRACK-TBI researchers have made progress toward more useful classification and prognosis of TBI.
Earlier this year, they reported that cases of concussion, or TBI that are classified as “mild” by standard criteria but that show abnormalities on early magnetic resonance imaging (MRI) scans, are much more likely to have worse outcomes three months after the scan in comparison to cases in which scans reveal no abnormalities. Furthermore, the researchers found that elevated blood levels of a protein released during brain injury was associated with the likelihood of an abnormal CT scan.
The new NIH award funds a continuation and expansion of TRACK-TBI. Among the goals is the creation of a widely accessible, comprehensive “TBI information commons” to integrate clinical, imaging, proteomic, genomic and outcome biomarkers from subjects across the age and injury spectra. Another goal is to establish the value of biomarkers that will improve classification of TBI and better optimize selection and assignment of patients for clinical trials.
The researchers also aim to evaluate measures to assess patient outcomes across all phases of recovery and at all levels of TBI severity, to determine which tests, treatments, and services are effective and appropriate – depending on the nature of TBI in particular patients.
In addition to Manley and Mukherjee, principal investigators for the newly funded project include Claudia Robertson, MD, Baylor College of Medicine; Joseph Giacino, PhD, Harvard University; Ramon Diaz-Arrastia, MD, PhD, Uniformed Services University of the Health Sciences; David Okonkwo, MD, PhD, University of Pittsburgh; and Nancy Temkin, PhD, University of Washington. Each of these leading experts has worked in the TBI field for two decades or more.
“The principal investigators bring expertise in neurosurgery, neurology, neuroradiology, critical care medicine, rehabilitation medicine, neuropsychology and biostatistics, all of which are essential and do not reside in any single individual,” Manley said.
International Funding and Collaboration
TRACK-TBI clinical enrollment sites throughout the United States will enroll 3,000 patients across the spectrum of mild to severe brain injuries. Clinical, imaging, proteomic, genomic and clinical outcome databases will be linked into a shared platform that will promote a model for collaboration among scientists within InTBIR and elsewhere.
In addition to the U.S. award, the European Commission, the executive body of the European Union, has awarded €35.2 million to fund the Collaborative European NeuroTrauma Effectiveness-TBI (CENTER-TBI) consortium, also part of the InTBIR. This project will collect data in over 5,000 patients across Europe, where 38 scientific institutes and more than 60 hospitals will participate.
In Canada, CIHR and its national partners also have made a multimillion dollar investment in TBI research, the details of which will be formally announced in the near future.
The InTBIR Scientific Advisory Committee met in Vancouver, British Columbia, on Oct. 17-18, and awardees from all three jurisdictions (EU, USA, Canada) now are aligning efforts to share resources and collaborate on strategies for achieving the InTBIR goals.