In many contact sports, a hit to the head is part of the game. But when it happens to a growing brain, what are the long-term effects?
This is one of several questions a new concussion study led by Johns Hopkins All Children's Hospital hopes to answer.
The hospital's Institute for Brain Protection Sciences is studying changes in brain function in high school athletes participating in sports with higher risk for concussion.
"The three-year study will look at the relationship between head impact forces among other factors, and cognitive and behavioral function over time," says Dr. Neil Goldenberg, director of research and one of the lead designers of the study. "The goal is to develop tools that can better diagnose and treat concussion and ultimately help young athletes participate in contact sports more safely."
The study will look at the effects of concussion and head impact on high school football, hockey and soccer players ages 15 to 18.
"We chose these three sports because hockey and football are two of the leading sports associated with concussion in the male population," explains Dr. Patrick Mularoni, medical director of the Pediatric Sports Medicine Division and primary investigator of the study. "And soccer is the leading sport associated with concussion in the female population."
Several concussion studies have been done at the NCAA and professional sports levels, but there are few that focus on high school athletes.
"Concussion is probably one of the leading causes of injury or impairment in adolescents and children," says Dr. George Jallo, director of the Johns Hopkins All Children's Institute for Brain Protection Sciences. "It's very important for us to do a study in adolescents because that's when their brain is developing and that's when they're going to have these head injuries."
Another critical question researchers hope to answer is why some athletes with multiple hits appear to have no long-term effects, while others with no history of concussion may have significant problems over time.
"This is probably the only study that's looking at students before the injury occurs to be able to get them tested before and after their head injuries occur," says Jallo.
Three separate testing tools will be used to study athletes before and after each sports season for changes in brain function: head impact sensors, biospecimens and neuropsychological testing.
"We're banking blood, urine and saliva specimens during the course of each student athlete's participation and follow up," explains Goldenberg. "Our goal is to discover if there are new biomarkers of brain injury and how a young athlete's body might respond to it."
During all practices and games, participants will wear a mouth guard, pictured at left, that includes a sensor (if playing football or hockey) or a headband (if playing soccer).
"By using the sensors, we're able to track the head rotation and also the velocity at which the athlete got hit," says Dr. Jennifer Katzenstein, clinical director of Pediatric Neuropsychology and a co-investigator in the study. "We're hoping to be able to define what level of hit might be a problem."
Neuropsychological tests will monitor changes in cognitive, emotional and behavioral functioning in student athletes with a diagnosed concussion and those who had multiple hits, but no diagnosed concussion.
Last year, Johns Hopkins All Children's Sports Medicine Concussion Clinic treated more than 500 concussion cases. The slippery slope with concussion is that it can't be detected on an MRI or CT scan.
The concussion study is made possible by a $500,000 grant from the All Children's Hospital Foundation. It's one of several ways Johns Hopkins All Children's is enhancing its research footprint by gaining insight that can help diagnose, treat and care for children not only in Florida, but around the world.
Students who participate will earn Bright Futures hours for the time donated to the study. "The athletes that are volunteering for this study are doing it to benefit science and benefit future generations," says Mularoni.
Now that's the true meaning of TEAMWORK.