Each football season ignites a drumbeat of media interest in concussion; all year round, research on the subject is flourishing. But despite substantial scientific progress and an uptick in public awareness, fundamental questions are still unresolved.
Is there a way to reliably identify when someone has experienced a concussion? Why do some people respond to the same impact differently than others? Can we prevent these injuries? And how should we treat them?
Since 2015, researchers at Virginia Tech have been participating in the most comprehensive concussion study in the world. The massive project, funded jointly by the National Collegiate Athletic Association and the U.S. Department of Defense, has received an additional $22.5 million to support two more years of research at universities across the country.
Virginia Tech’s team, which was awarded more than $1 million for research that will expand their ongoing work to new sports and investigate how gender affects injury response, is led by Stefan Duma, the Harry Wyatt Professor of Engineering and director of the Institute for Critical Technology and Applied Science.
Co-principal investigators are Steve Rowson, an associate professor of biomedical engineering and mechanics, and Stephen LaConte, an associate professor at the Virginia Tech Carilion Research Institute and in the Department of Biomedical Engineering and Mechanics.
The NCAA-DOD Concussion Assessment, Research, and Education Consortium, known as the CARE Consortium, was established as part of the broader NCAA-DOD “Grand Alliance” in 2014. The consortium has two goals: to understand how concussion affects the brain and to improve diagnosis, treatment, and prevention.
The study is led by Indiana University School of Medicine, the University of Michigan, and the Medical College of Wisconsin, in collaboration with the Uniformed Services University, and encompasses more than 30 universities. Virginia Tech is one of six technical leads.
For this phase of the study, Duma, Rowson, and LaConte assembled a team that combines expertise from the College of Engineering, the Institute for Critical Technology and Applied Science, the Virginia Tech Carilion Research Institute, and the Department of Sports Medicine. Virginia Tech's thriving culture of transdisciplinary research provided a supportive environment for an effort that weaves together biomechanics, psychology, physiology, and neurochemistry.
“We need all these partners to understand concussion and identify the best practices for our athletes,” said Duma, who broke new ground in head-injury research in 2003 when he began recording head impacts experienced by Virginia Tech football players. “This research wouldn’t be possible without imaging, without the trainers and team physicians, without great coaches who’ve supported our work. We’re fortunate at Virginia Tech to have this unique combination of resources.”
During the first round of the NCAA-DoD study, which ran from 2015 to 2017, Duma’s group focused on head injuries among collegiate football players. This time, they’re including men’s and women’s rugby and women’s lacrosse.
Duma explains that this broader approach is essential to address the field’s most pressing questions.
For example, data show that head injury rates are higher for female athletes. But the research to understand that disparity has lagged, partly because the majority of concussion studies are still conducted on male athletes.
“We’re going to build a database that will allow us to start answering some of these key questions,” Duma said.
The work will begin this fall, and will rely on methods Duma’s lab has developed for getting context-rich data about real head impacts — but this time, with even greater detail.
“The technology has evolved — we have better capabilities now than we did even three years ago,” Duma said. “The sensors are more sophisticated, imaging is more advanced, and we have identified more biomarkers we can test for.”
During practices and games, Virginia Tech athletes will wear sensors that record multiple parameters for every head impact they experience. Athletic trainers and team physicians will track any symptoms the players report, and conduct neuropsychological tests that evaluate indicators of brain function like balance and memory. Magnetic resonance imaging and blood biomarker tests performed at the Virginia Tech Carilion Research Institute will probe physical and chemical changes that accompany the athletes’ injury and recovery.
This will help piece together a deeper picture that links what happens on the field to what’s happening functionally and physiologically in the brain. The data will also help evaluate preventive measures and treatment strategies.
Collaborative brain research at Virginia Tech has been elevated by the Beyond Boundaries initiative, which formalized the university’s longstanding support for transdisciplinary collaboration.
One of the initiative's most visible outcomes has been Destination Areas that tap disciplinary strengths to unite diverse communities of scholarship around formidable societal problems. One of those, called Adaptive Brain and Behavior, has strengthened ties among experts across the spectrum of brain research.
“It takes people from all over Virginia Tech to answer complex questions about concussion and recovery, and the Destination Area structure has helped that team coalesce,” Duma said.
“You start conversations,” he explained. “When you start talking about your research questions and your capabilities, you discover that capabilities and interests that might seem very separate can actually come together in important ways.”