Novel concussion diagnostic technique in the works at USD

VERMILLION, S.D. -- Detecting concussions in the brain remains, to date, a somewhat imprecise science, based largely on behavioral and physiological observations. 

But a more accurate means of diagnosing a concussion -- an injury commonly associated with football -- might someday lead to better outcomes for those who suffer such injuries. A researcher at the University of South Dakota is working to develop such a diagnostic technique. 

USD associate professor of basic biomedical sciences Lee Baugh, who studies the brain, is leveraging special MRI scanning sequences and other testing, to make a diagnosis. His research on the subject remains in the "pre-clinical stage." 

"One of the things that is really difficult from a diagnostic perspective is, if you scan an individual's brain that we think has had a concussion, we really don't see much at all," Baugh said. 

Football has been, for years, beleaguered by accusations that concussions sustained in the game can cause serious, lasting damage to the brain, and that not enough has been done to prevent them. Some players have been found to suffer chronic traumatic encephalopathy, or CTE, which can cause cognitive and emotional impairment. 

The late Aaron Hernandez, a Patriots tight end and convicted murderer, was known for his erratic and criminal behavior in the years before he committed suicide in prison in 2017. A post-mortem examination of the 27-year-old's brain found a high degree of CTE damage.

Photos of Hernandez's dissected brain showed its interior was unusually cavernous for a man his age. 

USD head football coach Bob Nielson maintains that, although football is the best-known sport where players suffer concussions, the rate of concussions in football is, at least, no worse than what's seen in other sports. 

"You have a similar, if not higher rate of concussions in other contact sports, such as wrestling, and hockey, as you do in football," said Nielson, a head coach of 27 years.

His assertion is true -- an NCAA study found that concussions are more prevalent in wrestling and in men's and women's hockey than in football. 

Nielson said the team has put a lot of stock into the detection of head injuries.

"I'm assuming that every year we've dealt with at least one concussion or head injury. The thing that has happened more recently is, I think, that, we've done more in terms of our training of health staff to be able to identify those kinds of situations or potential situations, more so than 20 years ago," he said. "Therefore, every school now is required to have a protocol to deal with potential concussion-type injuries." 

Colby Keegan, an athletic trainer at USD, said sideline officials take note of the players' behavior and symptoms in their assessment of whether a concussion has occurred.  

"We had one this year where he got hit. Just watching, they went to run the next play, he wasn't lined up right. He obviously, no idea what was going on, so we pulled him. And we look at the symptoms, you know, memory, vision, you look at balance, and then just emotional -- a lot of people, after they get hit, they're just angry or sad for some reason, and don't really know why," he said.

"And then we do the impact test, which is, test reaction time, recall memory, and stuff like that, on a computer, for a definite diagnosis." 

Players who suffer concussions are entered into the "concussion protocol," Keegan said, and must meet certain criteria, including being free of symptoms of concussions, before they can return to the game. Concussed players are even held out of classes for a few days after the fact: "Most of our guys bounce back very quickly."

After a concussion, players will be out of the game for at least six days, though normally they're unable to play for about two weeks. Some have neurological symptoms "for a month," by which point the players may be directed to a neuropsychologist. 

More broadly (and not necessarily referring to USD players), Keegan said there are cases in college football where, for one reason or another, players' symptoms linger for quite a while, while an unfortunate few never totally recover. 

"Those are always really sad to see," Keegan said. "It's not necessarily the big hits that cause the worst concussions.

"You've seen kids who just don't bounce back the same." 

Often, Baugh said, the most effective way to determine if someone has suffered serious brain damage is to examine their brains on autopsy. Even then, deceased players' brains might appear to have only subtle changes -- unusual patterns in the tissue, atrophy of the white matter (one of the substances the brain is made of) and signs of past bleeding. 

"They're all very small differences that you're looking at," he said. 

Physically small and hard-to-notice though the injuries may be, these changes can wreak catastrophic damage. 

"Even after a single concussion, it's possible to develop what's known as post-concussive syndrome, where people have difficulty with attention, they may experience headaches, sleep disorders, anxiety, depression, it increases the prevalence of substance abuse. Very difficult problems to tackle when there isn't an underlying cause," Baugh said. 

"There've been studies now that show that even at the amateur high school level, it's not unusual for a patient or a player to experience an injury that could result in post-concussive syndrome." 

Abdul Hodge, USD's outside linebackers coach and NFL liaison who played for the Green Bay Packers, the Cincinnati Bengals and the Carolina Panthers during an NFL career spanning from 2006 to 2010, expressed a high degree of optimism about the state of concussion prevention at the college level. 

"Today, the game of football is as safe as it's ever been," Hodge said. In his years with the NFL, Hodge said he never suffered a concussion. 

Nielson maintains that technology has come a long way in shielding the brain. He pointed to a decades-old photo of his father and teammates in old-fashioned helmets, the kind which offered the wearer not even a face mask: "That's what my dad wore when he played." 

"Now you have a helmet that's created with a system that is designed to provide greater protection to the head," Nielson said. "Helmet systems have changed substantially to create a safer protective device."