$2 Million NIH Grant Will Fund Concussion Protocol Study

John J. Leddy, MD, clinical professor of orthopaedics and director of the UBMD Concussion Management Clinic, is co-principal investigator on the National Institutes of Health grant with Barry S. Willer, PhD, professor of psychiatry and the clinic’s research director.

Leddy and Willer pioneered the use of low-level exercise to help concussed athletes recover, an approach that directly contradicts the traditional standard of care mandating prolonged periods of rest.

The goal of the grant is to validate a concept they developed: that the inability to exercise above a certain intensity — exercise intolerance — is a biomarker for concussion.

“We want to demonstrate how exercise intolerance predicts recovery time. By studying cerebral blood flow through brain imaging, we will be able to better understand how the brain changes after a concussion and how it changes back again so patients can get on with their lives,” Willer says.

Leddy and Willer were among the first researchers to view concussion as a physiologic, as well as a cognitive, injury.

“The NIH recognizes a clear need for improved diagnostic and prognostic markers for concussion,” says Patrick Bellgowan, PhD, program director at the NIH’s National Institute of Neurological Disorders and Stroke. “Dr. Leddy’s innovative grant exemplifies NIH’s multidisciplinary strategy for accelerating understanding of concussion diagnosis and recovery.”

“We know that exercise is good for your brain,” Leddy says. “We’ve seen that exercise changes cardiac output and blood flow in the brain. When you exercise, you stress your brain the way you stress your heart.”

While rest is critical just after a concussion, the researchers note that prolonged rest can be detrimental to recovery.

“Prolonged rest can create anxiety and depression in athletes,” says Willer. “They end up focusing on their illness.”

The first grant Leddy and Willer received to study exercise as a treatment for post-concussion syndrome came from seed funding awarded by the Office of the Vice President for Research and Economic Development in 2008.

In recent years, a more proactive approach has been seen as potentially more beneficial, a point noted by the NIH reviewers, one of whom commented, “Who better to lead in this new approach than the people in Buffalo who have been saying this all along?”

About 90 teenagers who play sports will participate in a clinical study. Willer says the research on concussions will focus on teenagers because “they are the most vulnerable and they take the longest time to recover.”

“Adolescence is a time of dramatic change in the brain,” according to Leddy. During adolescence, he says, the brain is undergoing major hormonal changes, changes in blood flow and the maturation of the autonomic nervous system, which governs involuntary processes like breathing.

“By evaluating how much exercise a patient can do before they start having symptoms, our approach immediately confirms that a patient has had a concussion, but more importantly, it tells us how serious the concussion is and about how long it will be before we see full recovery,” Leddy says.

While most teens who suffer concussions recover pretty quickly, about 15 percent will exhibit symptoms for much longer, a condition known as post-concussion syndrome. For these individuals, recovery will take months, not weeks.

A case in point is Sean Kaiser, a senior at Frontier High School. Just days before going back to school his junior year, he sustained a concussion during football practice.

Almost as soon as Sean started walking on the treadmill, his physical symptoms, such as headache and dizziness, returned, a sign that he was also likely to be cognitively impaired.

“If a patient has exercise intolerance as Sean did, that typically indicates cognitive intolerance as well,” says Willer. “The person is as smart as he or she always was, but has very little stamina. For a high-achieving high school student like Sean, it can be devastating.”

Once Willer and Leddy knew that Sean’s recovery would take months, not weeks, they scheduled a meeting so they could properly inform his parents, his guidance counselor, the school nurse and all his teachers about how best to deal with Sean’s injury.

Willer recalls: “We told them, ‘There will be points in the day where he is going to hit a wall. At that point, he is taking in nothing. He needs to leave the room and go to a quiet place where there is no stimulation.’”

The teachers made numerous accommodations and Sean completed his junior year successfully. Knowing ahead of time that his recovery was going to take a long time was key, says Leddy, but adds there is still much more to be learned about how concussions affect both body and brain.

Leddy sees patients through UBMD Orthopaedics and Sports Medicine.