Jan 29, 2015
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A New View of Concussions

When it comes to identifying concussions, diffusion tensor imaging (DTI) is making waves in the medical community. Researchers who used the new MRI technique in a recent study found that concussed individuals have unique spatial patterns of brain abnormalities that change as time goes on.

The new technique could offer help in diagnosing concussions and predicting which patients will have persistent and progressive symptoms. While previous studies have found differences between the brains of people with and without concussions, this research delves into the differences between one concussion victim and another.

The study, published in a special online edition of Brain Imaging and Behavior in June, used DTI to view the brains of 34 patients who were diagnosed with mild traumatic brain injury, as well as 30 healthy control subjects. The patients, 19 women and 15 men between ages 19 and 64, were imaged within two weeks of suffering their injury and again three and six months later. The study authors then analyzed that data using Enhanced Z-score Microstructural Assessment Pathology (EZ-MAP), a new piece of software that allows researchers to, for the first time, examine microstructural abnormalities in the brain.

The images showed areas of abnormally low fractional anisotropy (FA)–a scale used to measure whether tissue maintains its microstructural integrity–in the concussion patients, but not in the controls. Each concussion patient also displayed a unique spatial pattern of low FA that changed throughout the study. This helps prove that people respond differently to concussions.

The abstract of the study “Robust Detection of Traumatic Axonal Injury in Individual Mild Traumatic Brain Injury Patients: Intersubject Variation, Change Over Time and Bidirectional Changes in Anisotropy” can be found by searching its title at: www.springerlink.com.

GPS for Injury Prevention

Many people use global positioning systems (GPS) technology to help them get from point A to point B in their car. But could it also help athletes avoid injury? Anecdotal evidence from two professional teams indicates that it may.

Craig Duncan, PhD, Head of Human Performance for Australian professional soccer team Sydney FC, believes that soft tissue injuries can be prevented if players wear GPS devices. The devices measure how much a player is working on the field by tracking his or her movements. Theoretically, if a player were overworking during practice, coaches would be aware that the athlete’s risk of injury was increasing and could decide to have them take a break or cut the practice short. GPS is generally preferred over pedometers because it is more accurate and real-time data can be tracked by coaches or athletic trainers on a laptop at the sideline.

FIFA, soccer’s international governing body, currently does not allow players to wear GPS during matches because the systems are not a part of the players’ basic equipment. But Duncan believes wearing the devices should be allowed.

“We have substituted players in preseason when these numbers start getting outside normal zones and also monitor loads in training to ensure injuries are prevented,” he told CNN.com. “As with any prevention initiatives it’s hard to say how much we have prevented, but I will say we have reduced injury rates at my club by over 60 percent this year due to careful monitoring. If we could use [GPS devices] in games, I do think we could prevent more, as many injuries are fatigue related.”

GPS technology is catching on in American football as well. The New York Giants used GPS devices, in addition to heart rate monitors and nutrition/hydration monitors, during off-season workouts this year. According to The New York Times, approximately 35 Giants players volunteered to wear GPS watches during workouts, which were monitored in real time on laptops.

“Currently, Coach [Tom] Coughlin comes to me and says, ‘Do you think the team looks tired?'” Ronnie Barnes, MA, ATC, the Giants’ Vice President for Medical Services, told the Times. “Or the players come to me and say, ‘Our legs are dead.’ And I’ll go up and say, ‘Coach, the guys are telling me they’re really tired.’ And usually he says to me, ‘Well, we haven’t done that much!’ But then he’ll make adaptations based on what I’ve told him. With this setup, I’ll be able to tell him, yes, they are tired.”

Protecting Athletes from Sudden Death

A new bill in Pennsylvania aims to protect the state’s student-athletes who have undetected heart conditions from sudden death while playing sports. House Bill 1610, the Sudden Cardiac Arrest Prevention Act, was signed into law by Pennsylvania Governor Tom Corbett on May 31 during a ceremony in Norristown, Pa., making Pennsylvania the first state to enact legislation to protect student-athletes from Sudden Cardiac Arrest (SCA).

The new law requires coaches, game officials, athletic trainers, and doctors to look for signs of cardiac arrest, such as fainting, difficulty breathing, dizziness, chest pain, and a racing heart rate, and remove any athletes showing those symptoms from competition immediately. To return to play, the athlete must provide a written note from a doctor, registered nurse, nurse practitioner, or cardiologist. Coaches must also participate in annual training on the warning signs of cardiac arrest and cannot coach their team until the training is completed.

Educational materials will be developed by the Department of Health of the Commonwealth and Department of Education to inform student-athletes, their parents, and coaches about SCA. The materials will be posted on the departments’ Web sites along with existing materials developed by organizations such as Parent Hearth Watch and Sudden Arrhythmia Death Syndromes.

The bill also outlines minimum penalties to be enforced by a school if a coach is found in violation of the terms of the new law. First-time violators are suspended from coaching any athletic activity for the remainder of the season, while a second violation will result in a suspension for the remainder of the current season plus the next season. A third violation would result in permanent suspension from coaching.

Altitude Training: When To Come Down?

Athletes at elite levels across many sports have found success with altitude training. But while most agree that the practice has its advantages, there are two opposing schools of thought on when an athlete should return from altitude to compete.

Robert Chapman, PhD, an exercise physiologist at Indiana University, and fellow IU researchers set out to see which camp was right. It turns out that both ways of thinking may be valid.

Their study “Time-course of changes in cardiorespiratory measures post-altitude training: Implications for competitive endurance performance” was presented in May at the American College of Sports Medicine annual meeting.

Researchers worked with six elite distance runners who lived at an altitude of 2,150 meters in Flagstaff, Ariz., for 28 days. The runners trained at 1,000 meters during that time in order to do harder and faster workouts. Once the runners returned from the camp, researchers tested their heart rate, running economy, and running mechanics over the following 26-day period.

The results showed that 48 hours after returning was a good time to compete based on breathing results, while days seven and 13 showed more breathing difficulty. But the study also indicated that an athlete might perform at his or her best between days 18 and 22 because the breathing difficulty went away and the body became re-acclimated to a lower altitude.

“This research will help athletes plan for major competitions,” said lead author Abby Laymon, a graduate student at Indiana. “For example, if an athlete is training for the Olympic trials, they can count backwards and plan their workout[s] accordingly to perform their best after altitude training.”

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