KU’s concussion center aims to find best ways to heal the brain

Jeff Radel used to joke about concussions. Like many people, he has had a few.

He got one as a competitive swimmer in high school when he banged his head against the side of the pool while doing the backstroke. He got another while building a tree house for his son.

“It was a pretty significant injury,” he said.

He didn’t get it checked out.

“What I did was come in and say to my wife, ‘Huh-huh. Guess what I did?’ ”

Today, as the research coordinator for the University of Kansas Hospital’s Center for Concussion Management, Radel knows concussions are no laughing matter. They are mild traumatic brain injuries that need to be evaluated by a concussion expert.

But even the best experts can’t help unless people know why it’s important to see one. Here’s why. Although 90 percent of people will recover from a concussion even if they do nothing, Radel said, 10 percent will not. And without proper care, those people could experience lasting consequences.

KU’s concussion center, one of several programs in the area, is not a building you can visit. It is a team of interconnected experts — surgeons, neurologists, sports medicine doctors, pediatricians, researchers, cognitive therapists, nurses and more — all specially trained and collaborating in a virtual workplace on high-level research, education, treatment and testing.

Michael Moncure, KU’s director of trauma services, is the center’s medical director.

“We all have different experiences and expertise,” he said. “And we can all sit down and talk to each other about different cases, particularly difficult cases. I don’t think we’ve ever not been able to come up with a good strategy for a patient.”

Recovery takes time, cooperation

The center sees 300 to 500 concussion patients a year. Only about 20 percent of the concussions are caused by sports, Moncure said. The majority result from falls and motor vehicle and bike crashes.

Just how do experts “manage” a concussion?

KU’s experts are trained to evaluate and treat symptoms, including headache, nausea, dizziness and problems with vision and balance.

“If your problems are dizziness or balance, we have physical therapists who have special vestibular training,” said Radel. “You will get therapy two to three times a week, and that will help restore your balance a lot faster.”

But even if you’re not having symptoms, Radel said, it’s important to understand that to get better as quickly as possible, the brain needs time to rest for at least a day and maybe longer. During that time there should be no driving, reading, TV, texting, loud music or video games until your doctor deems it safe to gradually return to normal activities.

That’s a hard message, especially for teenagers. But it’s important.

That’s why Radel and others, such as center coordinator Jill Kouts, talk as much as they can to parents, kids, coaches, teachers, administrators.

“You know the kid who gets hit on the football field and is told, ‘You can’t come back to practice till you’re better’?” Radel said. “He hops in his car and drives home. That’s a problem. You shouldn’t be driving a car after a concussion.”

And educators need to be educated, too, Radel said.

“Typically (a child with a concussion) has taken three to five days off, and they come back the next week. What do you think the teachers do? ‘You’ve been off for a week. Here’s your homework. And you missed two tests. You’re going to take one tomorrow morning, and another tomorrow afternoon.’ ”

That’s a concussion no-no.

A significant concern following a concussion, especially in adolescents, is receiving another blow to your brain before the first injury has healed, Radel said. That’s called second impact syndrome.

A tragic toll

More people are listening today than ever before as the movie “Concussion” has brought the issue of traumatic brain injuries to a wider audience. The movie focuses on the discovery of chronic traumatic encephalopathy (CTE) in the brains of professional football players.

[‘Concussion’ strikes a powerful blow at the NFL: 3.5 stars]

At the same time, deaths on and off the football field have brought the risk of brain injuries close to home.

Two high school football players from the Kansas City area have collapsed on the field and died in the past five years: Spring Hill senior Nathan Stiles in 2010 and Shawnee Mission West senior Andre Maloney in 2013.

By November, eight high school football players had died last year, including Luke Schemm of western Kansas.

Also last year, researchers at Boston University found that 25-year-old former Harrisonville High School defensive end Michael Keck (who played for Missouri State and briefly for Missouri, and died in 2013 of an unrelated heart condition) had advanced degenerative brain disease.

That is what the concussion center is working to prevent.

One KU study uses magnetic resonance spectroscopy to analyze the chemistry of a concussed brain. Specifically, researchers are focusing on tiny “breakdown products” called metabolites.

“The metabolite appears when a chemical in your brain has been altered,” Radel said. “We know that this profile changes after a brain injury. Theoretically we should be able to go in and look at the brain of someone with a concussion and say, ‘Not only can we show that you’ve had a brain injury … but we can do it again in a few weeks.’ If that profile has become more normal we can say, ‘We know you’re getting better.’ ”

The same analysis could be used to reveal the presence of metabolites in the brain of a football player far after a concussion.

“You may look like you have recovered,” Radel said. “But your brain is telling me you’re not.”

Such testing is expensive and time-consuming and may be impractical for frequent use. But the research does hold promise for the future.

Changes in treatment

Moncure and a few colleagues started KU’s concussion management center in 2012. The catalyst: Nathan Stiles.

Nathan, who was not treated at KU, did everything right, Moncure said. He saw a physician and sat out four games. He even had two CAT scans. In the final game of the year he was having one of his best games before screaming that his head hurt and collapsing just before halftime.

He never moved again.

Concussion experts wanted to know more, to do more.

“Today we could have offered (Nathan) different modalities of therapy that could have helped him,” said Moncure.

One is called an ImPACT test, a series of computer tests using a keyboard to measure reaction time, memory and more.

“And in the future there will be a blood test,” Moncure said. “It still needs to be studied more, but doctors would look for elevated proteins in the blood. If protein levels were too high that would be a sign that a patient was not ready to resume normal activities. I am hoping we (have that available) in the next couple of years.”

Another possible breakthrough in the near future: being able to identify someone as being at a higher risk for developing CTE.

“Not that you have it,” Radel said. “But for whatever reason, you are more vulnerable than someone else. As a parent of an athlete, that is something I would find useful to know in advance.”

Much has changed in concussion treatment over the years. Doctors used to give grades to concussions to gauge their seriousness. Now all concussions are deemed serious. Parents used to be told to wake up their concussed child every hour after the child went to bed.

Now?

It’s better to let the child sleep, experts said.

And that sickening hollow sound a child’s head makes when it hits a tile floor?

Doctors used to tell parents to relax. Experts don’t say that today. They recommend a trip to the emergency room, just to be safe.

Concussion coordinator Kouts said it’s hard to follow the rules following a concussion, but important.

“I don’t want people to go without treatment if their mind may not be working properly because I know what it’s like,” she said. “Three years ago (before working at the center) I had a concussion, and for two weeks I showed symptoms but rationalized them away. ‘Oh, I just have a headache,’ or ‘I didn’t get enough sleep.’ Then I got upset over something trivial, and my friends were like, ‘This isn’t you.’ ”

She finally realized she had had a concussion and “wasn’t processing correctly.”

She saw a KU concussion specialist and had therapy to help with her balance and to manipulate and realign her cervical vertebra.

It made all the difference.

“I’m really passionate about patient care,” she said. “I’ve been in their shoes. I understand where they’ve been.”

This story was originally published January 25, 2016 at 3:03 PM with the headline "KU’s concussion center aims to find best ways to heal the brain."