A group of researchers say a ‘structural health monitoring’ system often used to detect subtle damage in aircraft could also be highly useful in reducing brain trauma in sports. The team says greater use of medical imaging and impact monitoring could be particularly effective in protect the brains of players who do not show any obvious symptoms of concussion.
“We are saying that medical imaging can be used in re-characterizing traumatic brain injury, as a whole, to better identify at-risk individuals and improve the development of preventative and interventional approaches,” said Thomas Talavage, a Purdue University professor of electrical and computer engineering and biomedical engineering and co-director of the Purdue MRI Facility. “New data are revealing that athletes appear to be impaired for most of the year, not just during their competition seasons, and that they may not be fully recovering between seasons.”
Structural health monitoring is a comprehensive monitoring strategy using technologies such as computed tomography, X-rays, ultrasound, and magnetic resonance imaging (MRI) to reveal otherwise undetectable damage in aircraft that could lead to catastrophic failure.
“These tools ultimately became the foundation for the field of structural health monitoring, which has dramatically improved safety in the airline and automotive industries, military, and the food industry,” Nauman wrote in the journal Frontiers in Neurology. “It is reasonable to propose that structural health monitoring may be effectively applied to enhance brain health in cases where neurotrauma is a potential outcome. Such an approach necessitates that one interpret traumatic brain injury as a condition where an individual may gradually accrue symptom-inducing injury.”
One factor motivating the team is recent research indicating players experience changes in brain chemistry and metabolism even when not clinically diagnosed with a concussion.
“Integration of neuroimaging and biomechanical studies in youth collision-sport athletes has revealed that significant alterations in brain structure and function occur even in the absence of traditional clinical markers of concussion,” Nauman said. “Changes in brain metabolism will induce responses from brain cells that seek to restore the ionic balances associated with ‘healthy’ function. If we recognize these responses as efforts at ‘repair,’ we must also recognize that the alterations to metabolism represent ‘injury,’ even if they do not represent permanent structural or biologic alterations.”
The team recommends using sensors integrated into helmets to track hits to the head and monitor how well the helmet is absorbing impacts. The researchers also say that while using MRI scans to routinely monitor athletes, they believe it could serve as a “gold standard” as new, more portable alternatives are developed.
The recommendations are the result of the sixth year of an ongoing Purdue Neurotrauma Group study evaluating high school collision-sport and non-collision sport athletes. The team notes in the sixth year of the study they found that high school collision-sport athletes exhibit increasing rates of “deviant neurological assessment measures” as the season progressed. The deviations in neurological assessments even continued into the next season in many cases.
“The contact-sports athletes finally saw a recovery close to that of the control population four to five months after the end of the first competition season,” Nauman said. “The data raise concerns about the increasingly year-round nature of many youth athletic activities. Even at the time traditionally assumed to represent a ‘healthy’ measurement – immediately prior to the beginning of practice activities – the athletes are, in fact, altered relative to their non-collision-sport peers. This alteration is likely a result of summer practices, summer camps, and participation in summer competitions including football tournaments and travel soccer teams. So it appears the athletes are truly closest to being healthy, or are most neurophysiologically like their non-collision-sport peers, in the late spring, a time at which most spring practices or seasons now commence for traditional fall sports.”