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Concussion awareness has never been higher. However, the staff at Emerson’s Dr. Robert C. Cantu Concussion Center know that knowledge is the best way to counter the fear of concussion that affects student and professional athletes, as well as parents and coaches. The region’s largest and most respected concussion center successfully obtained funding that supports education and clinical research on promising technology, unique to Emerson, that is aimed at accelerating recovery from a concussion.

These are busy times at the Cantu Concussion Center. Its integrated treatment model, which draws patients from around the region and beyond, has led to steady growth, including the addition of neuropsychology staff. A three-year, $1,025,000 grant from Oak Foundation is helping to expand treatment capabilities, provide comprehensive concussion education and assess the impact of specialized equipment on post-concussion care.

Jessica Gravel, PT, DPTEarlier this year, the Massachusetts Department of Public Health (DPH) approved the center’s request to provide annual concussion awareness training for those involved with middle and high school sports. “It is a law in Massachusetts that students, parents, nurses, athletic directors and trainers receive this training,” explains Jessica Gravel, PT, DPT, senior therapist and the grant’s project manager (pictured at right). “Although they can access training online at the Centers for Disease Control website, it’s not interactive, so they can’t ask questions.”

There are plenty of questions, which concussion center staff answer as they fulfill the requirements of the DPH and the grant. “It’s clear as we educate the staff at area schools and non-profits that most don’t know the signs and symptoms of a concussion,” says Ms. Gravel. “We emphasize that you don’t need to lose consciousness to have a concussion, and all concussions are serious, whether they’re mild, moderate or severe.”

“We get to hear what youth coaches worry about,” says Matthew White, MEd, ATC, head athletic trainer. “During our educational sessions, they feed off each other and ask questions like ‘how do I handle a kid who’s had multiple concussions?’ and ‘how do I know if it’s okay for a kid to return to play?’ Many of them volunteer their time in youth sports. They’re not medical professionals, and they are aware of the responsibility they have.”

A good-sized crowd of staff, parents and coaches attended a recent presentation by Ms. Gravel and Mr. White at the YMCA of Central Massachusetts branch in Worcester. “People had a number of ‘aha’ moments, because kids sometimes play rough, and we don’t always know what symptoms to look for,” says Matthew Evans, wellness director at the Y. “Jessica and Matt discussed balance issues and mood swings. Weeks later, our staff were still talking about what they learned. We plan to have them come back in the spring.”

“The grant funding is getting concussion center staff out to places that need this information,” says Terrie Enis, PT, MSPT, center director. “In fact, the grant requires that we reach out to non-profits and schools where 50 percent of the students qualify for free lunch. For example, through this educational initiative, we are having an impact on kids at Boys and Girls Clubs in Fitchburg and Leominster. But we continue to also work with staff who oversee Sudbury football and Acton-Boxborough lacrosse. In some cases, we also perform baseline concussion testing.”

Clinical studies are assessing the newest technology

Thanks to the grant, clinical research is now underway to assess the impact of technology that Emerson is in a unique position to offer. “We’ve seen impressive responses in patients who have used our Vasper and MyoWorx equipment,” says Robert Cantu, MD, neurosurgeon and the center’s medical director. “We are conducting rigorous prospective studies to rule out the placebo effect.”

Vasper is a recumbent bicycle that includes cuffs on the upper arms and legs that inflate and cool. “The cuffs restrict blood flow, which results in the production of lactic acid and allows the body to produce growth hormone,” explains Dr. Cantu, noting that this is important for stamina and energy and thus directly affects concussion symptoms. “We are studying the effect of having patients exercise on Vasper with the cuffs on and off to see if this technology accelerates recovery.”

The MyoWorx study will determine whether or not this form of electrical stimulation better prepares muscles for the stretching, strengthening and massage that concussion center rehab staff administer to patients. “With both studies, we perform cognitive assessment, eye tracking and balance testing on patients who participate,” Dr. Cantu says. Concussion center staff are collaborating with Yi-Ning Wu, PhD, assistant professor at UMass-Lowell, who focuses on technology-based rehabilitation.

Ms. Enis recently was invited by Vasper staff to make a presentation at their headquarters, which is located at the Ames Research Center/NASA in Mountain View, California. “Their technology was developed to treat post-traumatic stress disorder, and they are now studying its use with astronauts, who need to exercise while in space,” she explains. “We are the only concussion center in the U.S. with this technology, so they are very interested in our work.”

Finding ways to play safe and smart

Cantu Concussion Center staff have defined a successful care model that combines comprehensive assessment and testing with a personalized treatment plan, delivered by experienced rehabilitation staff whose sole focus is concussion. Now they are defining how technology such as Vasper and MyoWorx can accelerate recovery.

The progress made by concussion center staff, including the grassroots educational efforts and clinical research, is a source of pride for Dr. Cantu, whose interest in concussion began decades ago on the playing fields of Acton. In his book, “Concussions and Our Kids”, Dr. Cantu suggested that kids younger than 14 not play collision sports such as football. This has influenced many younger kids to play flag football.

“There are many things you can do to play sports more safely, such as deferring playing some sports,” he says. “We want people to avoid injury, but we are making progress in understanding how the brain can take a fair amount and keep on ticking.” He now advises the National Football League on how to prevent concussions. “They are tackling and practicing differently and eliminating the head as a purposeful point of contact. However, football is going to have to get smarter.”

“People think we don’t want kids to play football, but that’s not true,” says Ms. Enis. “We want them to play safe and smart. Our goal is to use education to remove the fear of concussion. The more we get the message out there, the healthier we will be.”

Concussion education extends to domestic violence staff, police chiefs

Concussions don’t just happen during football, hockey and soccer games. As concussion awareness grows, it is clear that certain people are vulnerable. That is why Cantu Concussion Center staff were invited to make a presentation at the Domestic Violence Services Network, Inc. (DVSN).

“We are well aware of the physical impact, such as being bumped against a wall or shaken, that occurs in these relationships,” says Jacquelin Apsler, DVSN’s executive director. “The staff here wanted to better understand the signs and symptoms of concussion.”

Ms. Apsler had a bigger audience in mind: the 13 town police chiefs who attend a quarterly meeting at the DVSN to review statistics and discuss protocols. “I asked Jessica Gravel and Matt White to adapt their concussion presentation for police, who are vulnerable to head injury themselves, as well as for our domestic violence staff,” she says.

“It didn’t take long for us to connect the dots,” says John Fisher, Carlisle police chief. “When we deal with domestic violence victims, we want to understand the entire story of what happened to them. If there is a head injury, it has an impact on them, and it adds to the seriousness of the crime.

“As police officers, we are often injured in the line of duty from assaults and motor vehicle accidents,” he adds. “The presentation by the Cantu Concussion Center staff was the most polished one I’ve seen on the subject.”

“We all learned a great deal,” says Ms. Apsler. “Among the concussion center staff, the police chiefs and the domestic violence staff, there was real synergy.”