"Changing the Culture of Concussions"
  • Changing the Culture of Concussions
  • Changing the Culture of Concussions

Neuroscience faculty Joel Bish has turned from research to education. His students showed him the way. Together, they aim to change the culture of concussions through school programs and technology.

For the last six years, neuroscientist Joel Bish has been studying the long-term effects of concussions, learning that the effects linger long after the injury, especially for student-athletes who suffer more than one concussion during their playing years.

Now he is tackling something that may be more difficult than scientific research: changing the culture of concussion among sport-playing youth and their coaches and parents.

“When I watch a football game and a player gets hit in the knee, I wince I feel it,” he explained during an academic symposium held in conjunction with the presidential inauguration Oct. 16. “But if someone gets hit in the head, we don’t react strongly. That is what I’m up against.”

Up until a few years ago, Bish, an associate professor who holds a Ph.D. in cognitive neuroscience, was content to just do the research. He changed because of his students. “They see everything from the point of view of how they can help make things better,” he says. “That’s what we do. We educate students to give them the opportunity to take what they know out to the world.”

Enter the Ursinus Concussion Outreach Group. Not only will students track concussions in a new way, but they will educate the coaches, teachers and parents who work with adolescent athletes. Bish wants to include on our research teams student athletes, who have suffered from concussions, as real-life examples. A website and app in development to track symptoms could provide a national model for concussion safety.

“Education is not on the radar for enough people. A minor injury can snowball into detrimental effects.”
– Dr. Joel Bish, Associate Professor of Psychology

A typical scenario: A soccer-playing youth gets hit in the head with the ball. But the player feels fine the next day, the symptoms of nausea and temporary memory loss have subsided and she does not want to miss practice. Her parents may not be aware, however, that recovery of executive function, which affects decision-making and impulse control, takes longer.

Today, the general population is more aware of head injury from stories of athletes like former NFL running back Brian Westbook, whose memory loss forced him into early retirement after suffering several concussions. (He is now an advocate for head injury prevention.) And Will Smith stars in a movie titled Concussion, playing the doctor who found a link between concussions and memory loss among NFL players.

But more vigilance is needed, as well as awareness of the lingering trauma—especially among adolescents, whose frontal lobes are not fully formed, Bish says. The Concussion Research Group is developing a plan for area schools that will use a two-pronged approach: assessment and awareness. One group of students, including Summer Fellow Marisa Gretz ’16, is working on an educational component. Summer Fellow Daniel Brogan ’16, is working with math and computer science professor April Kontostathis on an app that will assess concussion recovery.

The extent of the geographic area the schools will include depends on a grant from the NCAA and U.S. Department of Defense, for which Bish is one of 20 finalists for 10 awards, which will be announced in February.

“Anonymity will be an important part of the assessment, Bish says. This is because only about 50 percent [of injured athletes] report concussions to coaches or teachers. Some continue to compete.” General research, with which Bish agrees, shows football players are the largest group to suffer concussions, but soccer is a close second, and field hockey and even cheerleading are contenders.

“Education is not on the radar for enough people,” says Bish. “A minor injury can snowball into detrimental effects.”

Recovery for children and young adults is often slower, he notes. Each time a person experiences a concussion, there is a buildup of proteins in the central nervous system that can prohibit the brain from functioning properly, interfering with learning, planning and organization.

The emphasis on concussion research at Ursinus was prompted by student-athlete. Caitlin McGee ’12, a neuroscience and exercise and sport science major and biology minor who played soccer. She piloted the initial project, which looked at football players. Bish programmed a series of tests for an athlete to perform, such as memory of shapes, and, to measure impulse control, how quickly a person could count the number of digits in a string of numbers, such as 3333—not name the actual digits.

“My initial interest had to do with brain injuries in the military population, but that obviously wasn’t a feasible study population at Ursinus,” says McGee, who is in the health services field. “However, I’d been working as a first responder with the athletics department, playing soccer for three years, and had had several concussions of my own, so Dr. Bish helped me transition my interest in brain injuries in general to brain injuries in the athletic population. We chose the football team since they were likely to be our richest source of concussions [high-risk/high-impact sport, large team]. My hope was to develop a project that would eventually compare brain injuries across athletic populations such as women versus men, football versus soccer versus rugby versus wrestling.”

The project began with a survey of all football players at Ursinus as well as several former players who had stopped playing due to injury but were still involved in the Ursinus program. Players who reported five concussions or concussions so severe that they had to stop playing were interviewed in person. Both the survey and the interview looked at players whose style may have put them at risk for injury, and took into consideration years of play, other sports played, and any long-term effects they felt might be related to their concussion history.

“We don’t want to just ‘tell about it’ but we want to really find a way to get to those who work with younger ages and have a way of showing what happens.”
– Summer Fellow Marisa Gretz ’16

Succeeding neuroscience students took on the research, such as Charles Lee ’14, who, as a Summer Fellow, explored changes that occur in the brain, specifically cognitive abilities. Lee and Bish found that impulse control can be impaired months after a concussion, and concluded that with this loss of impulse control, an athlete may put him/herself at greater risk for another concussion. Their work with EEGs (electroencephalograms, a test that records electrical activity of the brain) on concussed and non-concussed students and student athletes showed that concussed athletes showed concussion effects months after the injury.

This past summer and into the academic year, Gretz, a neuroscience and psychology major, took the research a step further, supported by a collaborative research grant from Lockheed Martin. Ursinus researchers performed a battery of cognitive tests, well-recognized as effective means of testing impulse control, on both concussed and non-concussed athletes. Results of two specific tests identified a permanent marker of concussion at six months post-injury, she reports.

In leading the schools educational team, Gretz says, “Our goal is the outreach. We don’t want to just ‘tell about it’ but we want to really find a way to get to those who work with younger ages and have a way of showing what happens.” The website and app designed by Brogan and supported by computer science professor Kontostathis is a self-assessment tool. Not only will it provide daily reminders of appointments, but it will regularly evaluates symptoms and offers reminders and recommendations. A warning might pop up if the subject is too active. It would ask, for example, “On a scale of 1 to 10, my headache is….” Kontostathis believes it is the first of its kind for concussions.

Because returning to play too soon before an athlete is fully recovered increases the likelihood that serious and irreversible neurological deficits can occur, the app would track symptoms so a doctor can have accurate information to diagnose a recovery. “People are more aware now, colleges have baselines, but we have to spread the same discipline across to adolescent athletes,” says Bish. The Ursinus Athletic Department has a detailed procedure and checklist for managing a head injury, including protocol for returning to play.

Bish’s own kids, 13 and 9, play baseball, basketball and soccer. “The main thing is to be aware,” he says. “I used to wrestle and we would never stop a match for a head injury. But from what we know now, there has to be a cultural change. A concussion can change your life.”