Aug 20, 2002 5 min read

PITTSBURGH – Researchers at the University of Pittsburgh School of Medicine and Carnegie Mellon University will objectively study, for the first time, the effects of single and multiple concussions on the brains of high and college athletes. The study, funded by a $3 million grant from the National Institutes of Health, will use functional magnetic resonance imaging (fMRI) to help determine when athletes can safely return to play following a concussion.

Concussion occurs when the brain is rocked violently inside the skull due to a blow to the head or upper body. Approximately 10 percent of all athletes in contact sports suffer a concussion each season. Concussion can disturb brain activities and symptoms may include disorientation, confusion, dizziness, amnesia, uncoordinated hand-eye movements and sometimes unconsciousness.

A noninvasive imaging technique, fMRI determines, through cerebral blood flow and metabolic changes, which parts of the brain are activated by various types of physical sensation or activity, such as sight or sound.

The University of Pittsburgh department of neurological surgery, in collaboration with the sports medicine program of the department of orthopedic surgery, the department of psychiatry and Carnegie Mellon University, will be studying 250 student athletes during the next five years.

“To our knowledge there have been no studies examining the effects of concussion on high school athletes. Yet, most at-risk athletes are at the high school level or younger. The majority of the 17 athletes who died following a second concussion between 1992 and 1997 were high school students,” said Donald Marion, M.D., professor of neurological surgery at the University of Pittsburgh School of Medicine and principal investigator of the study.

“Participants in aggressive contact sports, particularly football, hockey and soccer, are at increased risk for sustaining one or often multiple concussions which may cause long-term or permanent neurological dysfunction. There also is evidence that athletes who suffer a second concussion before they have fully recovered from the first are vulnerable to acute severe brain swelling or death,” said Mark Lovell, Ph.D., a neuropsychologist and assistant professor of orthopedic surgery, director of the UPMC sports medicine concussion program and co-investigator of the study.

“The results of this study are expected to provide a physiologic and anatomic underpinning for the cognitive deficits observed after one or more concussions in at-risk groups. This information should enable the development of far better and far more objective guidelines for who can safely return to athletic competition, to school or to work,” Marion said.

According to Marion, there are no reliable objective standards for determining when an athlete can safely return to play after a concussion, nor whether different criteria are needed depending on age or gender. There is evidence, he said, that concussions may have a greater impact on women than men.

“Such guidelines await clarification of the pathophysiology and long-term effects of concussion, which are poorly understood. Current standards of care vary widely and are based on subjective experiences,” he said.

Study participants, who have had a concussion or who are control subjects with no history of concussion, will first be testes with the ImPACT (Immediate Post Concussion Assessment and Cognitive Testing) neurocognitive test.

ImPACT is a 20-minute computerized test, developed by a team of researchers led by Dr. Lovell and Joseph C. Maroon, M.D., vice chairman of the department of neurological surgery. It measures brain processing, speed, memory and visual motor skills.

Within 24 hours of concussion, the participants will then undergo fMRI testing, which will consist of two different tests of memory and learning. Each time that a stimulus is presented on the screen, the participants will respond by pressing a button on a custom-designed response unit.

“As they perform the tasks, the MR scanner is continually acquiring date-one new series of images every 1.5 seconds. By comparing the images acquired in the different task conditions, we are able to determine not only which part of the brain is working during a particular part of a task, but also how much of the brain has been recruited to do the work,” said James Becker, Ph.D., professor of psychiatry, neurology and psychology.

“The fMRI findings, which will determine abnormalities in brain activation patterns, will be correlated with neurocognitive data shown in the ImPACT test. We intend to distinguish between the effects of single versus multiple concussions, the influence of age and gender on these abnormalities, and how these abnormalities correlate with academic performance at three and six months after injury,” Marion said.

Also involved in the study is Michael Collins, Ph.D., a neuropsychologist who is an instructor in the department of orthopedic surgery and assistant director of the sports concussion program. Collins is assisting in the coordination of the neurocognitive testing. Fernando Boada, Ph.D., and Andrew Stenger, Ph.D., assistant professors of radiology, are coordinating the fMRI studies. William Eddy, Ph.D., professor of statistics at Carnegie-Mellon University, an acknowledged world leader in the analysis of fMRI data, is providing statistical support for the study. Melvin Field, M.D., resident in neurological surgery and Kristen Hawn, P.T., are providing overall study coordination.

Study consultants include Freddie Fu, M.D., chairman of the department of orthopedic surgery, and Joseph C. Maroon, M.D., vice chairman of the department of neurological surgery.