Interview: Professor Eric Nauman, leading traumatic brain injury researcher

For more than five years, Professor Eric Nauman of Purdue University College of Engineering and his colleagues – Dr. Tom Talavage and Dr. Larry Leverenz, – have conducted one of the nation’s most in-depth human research trials on the subject of traumatic brain injury.

The research team works with Purdue football players as well as Lafayette-area high school football and soccer players.  They give each player a cognition test known as ImPACT as well as an MRI to help identify how difficult the brain must work to answer the test questions.  This battery of tests begins before the season to determine each athlete’s personal baseline and continues throughout the season.

During each practice and game, the researchers fit accelerometers on to the athletes’ heads or helmets.  The researchers use the accelerometers to follow each players’ impacts to the head, and often extend after the season to determine if there are any changes now that the athlete is no longer experiencing regular head impacts.

The team’s work has been featured in Sports Illustrated, as well as NOVA, Frontline, and HBO’s Real Sports with Bryant Gumbel.  Dr. Nauman also recently attended the “Healthy Kids and Safe Sports Concussion Summit” called by President Obama at the White House.   Dr. Talavage is a member of the NCAA’s Concussion Task Force, and Dr. Leverenz is a member of the GE/NFL Head Health Initiative Medical Advisory Board.

You and your colleagues published a study in the Journal of Neurotrauma that has sparked extensive attention. What was the central argument of this study?

Our main thesis is that the hundreds of subconcussive blows football players receive each season can contribute to traumatic brain injury just as much or even more than the rare major blow to the head. Our research has shown us that no particular magnitude of hit correlates with a concussion.

In the group of athletes you discussed in your paper, those with the most impaired visual memory skills were not those who had been diagnosed with concussions, but those who had received the most hits.  But you also said that same group remained completely asymptomatic.

During that study, we were seeing players who have never been concussed, were not verbally impaired – were even asymptomatic as far as their parents are concerned – but the MRI was showing very clearly that their visual memory and other neural circuits were more impaired.  That was a study conducted fivr years ago, and we are still seeing the same trends today.

But if the only way to know there is a problem is only appears on an MRI, is it really a problem? No symptoms, no problem, correct?

Incorrect.  There are so many health problems that are detected by advances by technology before they are symptomatic – it doesn’t make them less real.  I can’t imagine how a potential cancer patient would feel if she learned her doctor opted not to use the latest diagnostic technology but instead only decided to detect tumors after they were symptomatic.  The brain is part of the body, and we have the technology to understand what it is telling us.  We just have to be smart enough to listen to it.

Our cognitive test asks the participant to do a series of very simple tests, showing a series of random letters with one letter occasionally repeating.  The participant just has to say whether the letter they are looking at appeared one letter back or two letters back, based on their working memory.

Our study is designed to examine how hard to athlete’s brain is working to complete this test.  We have completed a baseline test before the season, allowing us to see how hard their brain typically has to work, and then again after they begin being hit.  What we are seeing – invariably, year after year – is that their brains are working much, much harder than they should have to in order to solve very simple problems.  If their brain is working this hard to solve the simple problems, what does it mean for the harder problems?  And can the brain keep healing from this much damage?  There are many questions we need to answer.

If a parent wants their child to play a “safe” sport, which sport do you recommend?

There are sports that pose much higher risks than others basically due to the physical nature that is intrinsic to the sport.

That is why there are four categories of sports: combat, collision, contact and then limited contact / non-contact sports. Combat would be like boxing and mixed martial arts, which I would not consider an option if safety is your priority.  Collision sports include football, ice hockey, lacrosse and rugby.  Contact sports include basketball, field hockey, soccer, and wrestling.  Other sports – like baseball, tennis, track and swimming – fall into the limited / non-contact categories.

This does not mean swimmers and baseball players won’t get injured.  We have talked to more than one swimmer who has received a concussion hitting his or her head on the wall.  But rough contact with an opposing player is not intrinsic to their sport.  So, you could consider swimming or baseball if you don’t want your child to be in a contact or collision sport, but risks still do exist.

If my son plays football and risks exist no matter what, why should I worry about something that is beyond my control?

One of the best precautions against head injury in football is safe playing technique, and those are within your control.  The coaching mantra, “You can’t tackle what you can’t see,” is vital. If your son is being taught to lead with his head when he tackles, and to use his helmet as a weapon, your son’s coach is putting him at risk for a serious head injury.  Do not put all your faith into an expensive helmet.  They are currently tested simply to prevent skull fractures.  Be sure your son has a good coach.

About the author: dianna Huddleston is the Director of Outpatient Services at Aspire Indiana’s Carmel outpatient office. While the beliefs and opinions expressed in this blog are solely those of Ms. Huddleston and the interviewee, you can learn more about Aspire Indiana at https://www.facebook.com/AspireIndiana.  You can also follow Ms. Huddleston on Twitter @littledhudd.

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