PUCCS-Funded Studies

PUCCS recently awarded $35,000 to two University at Buffalo departments to further understand concussions. PUCCS granted UB’s Department of Orthopaedics’ study, which involves evaluating the overall lifestyle, cognitive strengths, behavior patterns and physical health of former professional athletes. PUCCS also awarded UB’s Department of Neurosurgery two grants that will be used to research biomarkers to help with the process of diagnosing concussions and using CT perfusion scanning for predicting post-concussive deficits.

Impact of PUCCS 2012-13 Funding on Studies Led by University at Buffalo, Department of Orthopaedics and Psychiatry

PUCCS financial support has been used to develop and implement studies of concussion in young people. Funding was initiated June 2012. The funding was used in combination with funding from the Ralph Wilson Family Foundation, the Robert Rich Family Foundation and the National Football League Charities Foundation. As such, publications on the research conducted acknowledge the support of each of these funding sources.

The PUCCS funding has been used primarily to support five studies:

  • 1. The first study is complete and looked at the usefulness of the Buffalo Concussion Treadmill Test (BCTT) in determining the return to play decision for adolescents. 80 adolescents who received concussion in sports were assessed on the BCTT. They were also assessed using computerized neuropsychological (NP) testing. Subjects that passed the BCTT were then returned to play using the Zurich return to play protocol. Follow up indicated that all 80 subjects returned to play successfully. Some athletes, however, had difficulty with return to school. NP testing did not predict return to play success or return to school difficulties.

    This study has been submitted for publication with acknowledgement of support from PUCCS.

  • 2. The second study is also complete although not yet ready for publication. This study looked at heart rate (HR) and perceived exertion (RPE) for subjects with post concussion syndrome (PCS N=37) versus subjects with cervicogenic issues (N=101) and subjects who previously had concussion but were now recovered (N=28). All subjects were tested on the Buffalo Concussion Treadmill Test. Subjects with PCS had significantly lower HR and significantly higher RPE for each minute of exercise when compared to the other groups. We conclude that concussion disrupts the autonomic nervous system and therefore subjects with PCS have lower heart rate because the parasympathetic system does not release the sympathetic system to raise the heart rate in anticipation of exercise.

    This study has been approved as a poster at the American Medical Society for Sports Medicine, April, San Diego, with acknowledgement of support from PUCCS. Preparation of a publication will follow.

  • 3. The third study recently received IRB approval and looks at the safety of the BCTT for acute concussion. The subjects are adolescents with acute concussion (N=40) who will be randomly assigned to receive the BCTT or not. A comparison group of subjects with orthopedic injuries will also be randomly assigned to receive the BCTT or not. The primary outcome measures include (1) time to recovery, and (2) symptom reduction. We hypothesize that use of the BCTT early after concussion will not slow recovery or alter symptom patterns. This study required extensive review by the IRB and recruitment of subjects is just begun.

  • 4. The fourth study is the “Healthy Aging Mind” study. The purpose is to examine former professional athletes that played contact sports like football, hockey, rugby, etc. There is some evidence based on post mortem examinations that these athletes may be at risk for early onset dementia, more specifically chronic traumatic encephalopathy (CTE). The current theory is that CTE results from repeated concussions during the playing years. Through consultation with the Alumni of the Bills and Sabres we have focused the study on evaluating the overall lifestyle, cognitive strengths, behavior patterns and physical health of these Alumni. The former athletes want to know what works with aging rather than what does not work. They also wanted to have something in place for referrals or support if the project evaluation uncovers specific health issues.

    Five committees were established using faculty, students and community health care providers. In total there were 25 faculty members from the UB Schools of Medicine, Nursing and Public Health who participated on committees. There were three residents, three graduate students, and one medical student also involved on committees. Each committee focused on an area of investigation: (1) Life style, which includes nutrition, exercise and sleep patterns; (2) Behavior, which includes mental health and addictive behavior; (3) Cognition, which includes memory and executive function; and (4) Physical Health. The fifth committee established the protocol for MR imaging.

    Each committee had the responsibility of reviewing the literature on healthy aging, CTE and assessment within their area of concern. Based on this they presented a proposed assessment protocol that was reviewed by the executive committee for the project. The executive committee evaluated the proposed assessments looking for redundancy and appropriateness to research hypotheses. The executive committee also evaluated the assessments in terms of the time and effort required of the former athletes that take part in the study. We did not want participation to be too burdensome.

    This project is currently under review by the IRB and should be approved within the next few weeks. In the meantime, one committee’s review of the literature is currently being prepared for publication. The physical health committee is preparing a publication on guidelines for physician exam of patients with suspected concussion.

  • 5. The fifth project is funded by the National Football League Charities but is also supported by the private foundations including PUCCS. The purpose of this project is to evaluate return to play guidelines for professional athletes (Sabres and Bills) as well as varsity athletes. Athletes (N=30) will be evaluated for return to play using the current (Zurich) protocol and the clinical judgment of the team physician. However, concussed athletes will also be evaluated using the Buffalo Concussion Treadmill test and advanced imaging. We hypothesize that some athletes will be found unready to return to play on the BCTT or through advanced imaging despite approval from the team physician. In these instances, the data will be shared with the team physician and a decision made regarding safe return to play. A control group (N=30) of athletes from the same teams who are not concussed will also be evaluated on the BCTT and advanced imaging.

    This project will also address some issues related to physiology of concussion. We are especially interested in the effects of concussion on autoregulation of cerebral blood flow. We have hypothesized that symptom exacerbation during graded exercise is the result of poor regulation of cerebral blood flow. We will test this hypothesis by administering diamox during MR imaging. This project is under review by the IRB and approval is imminent.

PUCCS (Program for Understanding Childhood Concussion and Stroke) Announces Grant Awards for 2012-13

PUCCS (Program for Understanding Childhood Concussion and Stroke) has awarded two grants in support of childhood concussion and stroke research.

University at Buffalo, Department of Orthopaedics and Psychiatry has been awarded a one-year grant in the amount of $41,825 which will fund two studies. The first study will research acute concussion and recovery in high school age athletes and the second, a Buffalo Bills/Sabres Alumni study, will assess for early signs of chronic traumatic encephalopathy (CTE), a progressive degenerative disease diagnosed post-mortem in individuals with a history of multiple concussions. The Congress of Neurological Surgeons (CNS) has been awarded $15,000 to underwrite a CNS Subspecialty Fellowship Award, based on the aims and mission statement of PUCCS.

Dr. Elad Levy, Professor of Neurosurgery, Radiology, University at Buffalo Neurosurgery and Director and Founder, PUCCS, says, “The goal of PUCCS is twofold: the first is to raise awareness and educate the community about concussion and ‘return to play’ rules for young athletes. The second goal is to generate funding in support of research so we can better understand what causes concussion, how we can prevent concussion, and how we can treat concussion. We want to make parents, coaches and the community aware of the devastating effects a major concussion can have on our children. We are thrilled to be able to award these grants that will further our mission of concussion and stroke education and research.”