Spit It Out! How saliva may provide the key to sports-related concussion

concussionSRxA’s Word on Health has reported several times on the problems of concussion among football players and cheerleaders. So we couldn’t help but sit up and take notice of an article in our local newspaper about some cutting edge research taking place yards from our front door.

The third floor of Bull Run Hall on George Mason University’s Prince William campus plays host to plenty of mind-bending science projects – laser capture microdissection, protein electronics and high-resolution mass spectrometry to name but a few.

Yet the most complex and potentially influential findings to emerge from the school’s College of Science might come down to a kid spitting in a cup after football practice.

Once a week athletic trainers collect saliva samples from the 12- and 13-year-old kids playing for the Jets, an A-League football team in the Central Loudoun Youth Football League. Then they send them to Dr. Shane Caswell, a George Mason professor and pioneer of the world’s first salivary biobank designed for concussion research in athletes.

Caswell stores the saliva in a freezer he dubs the “spit repository.” He eventually extracts the samples and runs them through sophisticated machinery to determine changes in protein variance. By comparing each kid’s spit samples to previous submissions, he hopes to uncover a handful of proteins that can detect concussions.

George Mason scientistsWorking alongside Caswell is Dr. Chip Petricoin. Long accustomed to studying protein biomarkers for cancer research, Petricoin never imagined he’d wind up plying his trade for studies on traumatic brain injury and concussions.  But the seed was planted six years ago, when he was called up to Fort Detrick to conduct a site review for a company that had been given a grant from the army to do concussion research. Petricoin admired their efforts, but he realized that his own work with cancer biomarkers could reap significant benefits for the concussion research that remained in its nascent stages.

A year later he found himself working in the same building as Caswell, whose extensive background in athletic training was getting him increasingly involved with concussion research. The two discussed their respective endeavors and quickly realized they could join forces.

The university’s College of Science and College of Education and Human Development began funding their efforts last year. Since then, Caswell and Petricoin have begun to explore the vast quantities of information stored in athletes’ salivary biomarkers.

Think about the biomarker content of a sample like an iceberg,” said Petricoin, co-director of the university’s Center for Applied Proteomics and Molecular Medicine. “The concept of what you see is only the tip of the iceberg? That’s kind of like biomarker research. Things that have been seen before are just the tip of what really is there. If we could go all the way down and see everything, you’d see a whole new iceberg. So we’re kind of going a mile deep now in the iceberg biomarker research.”

athlete spittingIndeed, the depth of these largely uncharted waters became apparent when the duo began their work with the Jets this fall using eight saliva samples. A few weeks after collecting those baseline samples, they used the nanotechnology at their disposal to examine new samples from four of the same kids who had recently suffered concussions. After compiling a list of proteins, they found that 60% of their list featured proteins that had never been described.

The process generates an information archive that’s larger than anyone’s ever seen before in saliva,” Petricoin said.

Caswell and Petricoin are currently working on 37 concussion cases, a total that increases every week with new samples arriving from different sources. They’re collaborating with Prince William County Public Schools, as well as intercollegiate athletics at Marymount University and George Mason.

The Jets’ head coach, Rob Scola, says his team has so far adapted nicely to the study. George Mason sends a certified athletic trainer to the field to provide care and to collect data on hits the players endure. The trainer tapes every game and practice, something that allows coaches to see what they’re doing right and wrong in their efforts to teach proper heads-up tackling techniques. Players also wear helmets with sensors that detect the force and location of impacts sustained in practices and games.

It’s all part of an effort to determine what measures coaches should take to minimize players’ risk of head trauma on the football field, where the rate of brain injuries is higher than in any other youth sport.

It’s very hard to get information from a very small team in a very small league and then extrapolate that,” Scola said. “I think that as Mason starts to expand the study, I think there will be some really interesting pieces of information that come from that, which I believe can be helpful to the league and football as a whole. I think it’s a phenomenal first step.”

Part of the project’s appeal lies in its lack of hassle. Biomarker work has traditionally come from blood and spinal fluid samples, which are rooted in far more invasive processes than simply spitting in a cup.

If I were to go out on the field and say, ‘Hold on a second. I want to take your child’s blood or their cerebral spinal fluid.’ That’s game over. We can’t move forward,” Caswell said. “This is a non-invasive tool that is rapidly deployable. There’s no threat of infection, it’s easily done and it provides a great deal of information.”

Caswell and Petricoin’s work with the Jets has opened the door to broader studies that extend to the entire lifespan of an athlete’s career. The hope is that parents will have their children give samples when they begin participating in youth football, ice hockey, soccer, or whatever sport they choose to play. They can then follow that up by giving more samples as they pursue the sport in high school, college and beyond.

“You are then able to track at various time points throughout someone’s career and identify how their marker is changing and then maybe one day compare it to a database that could help inform decisions about whether or not that individual should retire from play, whether that individual is suffering any adverse consequences from their participation,” Caswell said.

blue mouthgardEven more ambitious is their ultimate goal of implementing the biomarkers into a clinical diagnostic device. Petricoin envisions a mouthguard that turns from clear to blue when a concussion is detected. The technology, he says, is there – impregnating the nanoparticles into the mouth guard, binding the biomarkers and producing a color shift are concepts that have already been engineered.

The hard part is nailing down the biomarkers. For the moment, all Caswell and Petricoin are trying to do is identify what’s in the saliva. As the data mounts, they hope to reveal protein distribution patterns that coincide with repeated head trauma.

Caswell, a former hockey player who once returned to the ice minutes after suffering a concussion only to realize minutes later that he wasn’t carrying his stick, believes those patterns will come and that his team is well-positioned to make meaningful discoveries that could impact concussion policies on a greater scale.

If and when they do, we’ll be sure to let you know.

SRxA-logo for web

Heads Up on i-Concussion

NAU footballThere is a new face at Northern Arizona University (NAU) football games this fall.  No – not a new quarterback or coach – but a robot on wheels!

Making its debut at the season kick-off game against the University of Arizona in Tucson last Friday, the robot has the ability to assess a player for symptoms and signs of a concussion and to consult with sideline medical personnel thanks to a specialized camera system, remotely operated by a Mayo Clinic neurologist.

teleconcussion robot Mayo Clinic will be working with NAU to test the feasibility of using a telemedicine robot to assess athletes with suspected concussions during football games as part of a research study. With sophisticated robotic technology, use of a specialized remote controlled camera system allows patients to be “seen” by the neurology specialist, miles away, in real time.

Athletes at professional and collegiate levels have lobbied for access to neurologic expertise on the sideline. As we seek new and innovative ways to provide the highest level of concussion care and expertise, we hope that teleconcussion can meet this need and give athletes at all levels immediate access to concussion experts,” said Bert Vargas, M.D., a neurologist at Mayo Clinic who is heading up the research.

This study is the first to explore whether a remote neurological assessment is as accurate as a face-to-face evaluation in identifying concussion symptoms and making return to play decisions. Mayo Clinic physicians will not provide medical consultations during the study, they will only assess the feasibility of using the technology.

But, if it appears feasible, this may open the door for countless schools, athletic teams, and organizations without access to specialized care to use similar portable technology for sideline assessments.

teleconcussion robot 2As nearly 60% of U.S. high schools do not have access to an athletic trainer, youth athletes, who are more susceptible to concussion and its after-effects, have the fewest safeguards in place to identify possible concussion signs and symptoms at the time of injury. Teleconcussion is one way to bridge this gap regardless of when or where they may be playing.” Says Dr Vargas.

Others involved collegiate sports agree.

At NAU, our primary goal is to provide an outstanding student-athlete experience culminating in graduation,” says Dr. Lisa Campos, vice president for Intercollegiate Athletics at Northern Arizona University. “We charge our staff to research the most current and best practices to ensure the safety and care of our students. Partnering with the Mayo Clinic in its telemedicine study will further this research and potentially improve diagnosis for rural areas that may not have access to team doctors or neurologists. The study allows the NAU Sports Medicine Staff and team doctors to continue to make all diagnoses and return to play decisions for our students, while investigating the effectiveness and efficiencies of telemedicine. We are excited to have the teleconcussion robot on our sideline this fall.”

concussion_footballThere were a number of examples last football season where college football players clearly demonstrating concussion-like symptoms were quickly thrown back in games or weren’t even taken out of the game for an evaluation,” said Ramogi Huma, executive director of the National College Players Association. “College football players are in desperate need for independent concussion experts on the sidelines, and this study could help make that safeguard a reality.”

Telemedicine is not new to the Mayo Clinic in Arizona.  They first used the technology with the telestroke program in 2007, when statistics revealed that 40% of residents in Arizona did not live in an area where they were availed of stroke expertise. Since the telestroke program began nearly 3,000 emergency consultations for neurological emergencies have taken place.

We’ll be following the results of this study and will let you know the results as soon as they’re in.

SRxA-logo for web

Multitasking as a Diagnostic Tool?

Here at Word on Health we’re used to doing a million things at once. So over the years, we’ve  heard most of the multitasking jokes. Admittedly we’ve chuckled at the male definition known as chewing gum and breaking wind at the same time.  We’ve even been known to smile when men ask, “if women are so good at multitasking why can’t they have sex and a headache at the same time?”

However, it turns out that it’s no laughing matter.

Scientists hope to use a simple multitasking challenge – walking and thinking at the same time –  to quickly screen individuals who may have suffered brain injuries. According to researchers at the Georgia Tech Research Institute (GTRI) asking an individual to walk a short distance while saying the months of the year in reverse order, can determine if that person is impaired and possibly suffering from a concussion.

This simple test involving radar, which could be performed on the sideline of a sporting event or on a battlefield, has the potential to help coaches and commanders decide if athletes and soldiers are ready to engage in activity again.

When a person with a concussion performs cognitive and motor skill tasks simultaneously, they have a different gait pattern than a healthy individual, and we can identify those anomalies in a person’s walk with radar,” said GTRI research engineer Jennifer Palmer.

More than 1 million concussions and other mild traumatic brain injuries are reported each year in the United States.  Catching them right after they happen can improve treatment and prevent further injury or other long-term health issues. Diagnosing concussion can be difficult, though, because the symptoms are not always easily visible or detectable, even though they last for weeks or months following the incident.

While methods exist for detecting concussion, most focus purely on cognitive impairment and do not assess accompanying motor skill deterioration.

Details of GTRI’s technique, which simultaneously examines a person’s cognitive and motor skills, were presented on April 26 at the SPIE Defense, Security and Sensing conference in Orlando. Using radar for gait analysis would be faster and less intrusive than existing techniques. The assessment would be done with radar systems similar to those used by police for measuring the speed of vehicles.

The GTRI research team compared how 10 healthy individuals walked normally and when impaired. For the impairment scenario, individuals wore goggles that simulated alcohol impairment. Past research has shown that concussion impairment is equivalent to having a blood alcohol level of 0.05%.

Each individual performed four 30-second walking tasks: a normal walk, walk while saying the months of the year in reverse order, walk while wearing the goggles, and walk while wearing the goggles and performing the cognitive task. For each task, the subjects walked away from the radar system, turned around and walked back toward the radar system.

By looking for differences in the gait patterns of normal and impaired individuals, researchers found that healthy individuals could be distinguished from impaired individuals wearing the goggles. Healthy individuals demonstrated a more periodic gait with regular and higher velocity foot kicks and faster torso and head movement than impaired individuals when completing a cognitive task.

The results also indicated that if no cognitive task was performed, a healthy individual’s gait pattern was not statistically different when wearing and not wearing the goggles.

We found that we needed to examine a person’s physical and mental capabilities at the same time to see a change in gait and detect impairment,” said research engineer Kristin Bing. “It’s easy for a person to concentrate on one task, but when that person has to multitask we can begin to discriminate between someone who is impaired and someone who is not.”

In the future, the researchers plan to reduce the size of the system so that it becomes more practical to use.

Although approval from the Food and Drug Administration will be required before this system can be used to diagnose concussion, seems this multitasking tool is no joke.