NTX Magazine Volume 9 - Page 64

NORTH TEXAS ON THE BRAIN We are asking ourselves, ‘How can we speed recovery times in a safe way?’ Dr. Reynolds explained. “We are looking at this idea that in the first 24-48 hours after an injury, yes, the patient rests. But then we have them get back up and exposed to life in a carefully supervised way, and we have found that’s really beneficial. We are looking at all the variables – sleep schedule, nap schedule – anything we can do to help the process of concussion recovery.” Dr. Reynolds and other caregivers work with students in Frisco ISD and in other school districts to help students recover from their concussions as well as adults suffering from concussions. “Eighty percent of people with concussions will recover in seven to 14 days,” she said. “But the ones that are not recovering are those who need additional support.” And if you think the sport of football makes up the bulk of Dr. Reynolds’ patients, you would need to think again. “Certainly, we see them – but they make up a very small percentage of what we see in clinic. Females are actually more prone to concussion, particularly female soccer and volleyball players.” Dr. Reynolds has treated injuries from sports ranging from baseball, hockey, soccer and lacrosse to cheer, dance, gymnastics, marching band and more. She also sees adults injured by “head-butts” from their toddler or dog, and, once, a teen working a haunted house whose costume, a straight jacket, prevented her from being able to catch herself as she hit her head during a fall. “You name it,” she said. At Baylor Scott & White Sports Therapy & Research at The Star, Dr. Reynolds and other researchers consider community education a main tenet of their role. “One of our focus areas is advocacy,” she said. “The number one thing I tell people is that concussion is a treatable injury. Our goal is to educate as many people as possible as to what to look for and what to do about it. We also want to spread the message about treatment methods like active recovery. Childhood obesity is a big problem and yet, unfortunately, some parents are pulling their kids from sports for fear of concussions. This partnership is really to keep kids active and keep the community active through education.” Since 2002, Baylor Institute for Rehabilitation has been designated as a Traumatic Brain Injury (TBI) Model System Program by the National Institute on Disability, Independent Living, and Rehabilitation Research. Shahid Shafi, MD, is the 62 WWW.NTC-DFW.ORG SUMMER 2018 same benefit in humans, it could provide a powerful addition to current therapies, said Dr. Michael Kilgard, professor of neuroscience at UT Dallas and a study author. principal investigator for the competitively awarded grant, which helps to continue the healthcare system’s role as a national leader in TBI research and patient care. In addition to providing on-site patient care at Baylor Scott & White Sports Therapy & Research at The Star, which can include physical therapy, nutritional experts, diagnostic imaging and more, the providers there will be collaborating with healthcare institutions across the country to share research into best practices related to treatment of concussions. Warning signs you may have a concussion and need emergency medical care: worst headache of your life increasing confusion or agitation very drowsy or cannot be wakened persistent vomiting slurred speech Common symptoms of concussion: Physical • Headache • Nausea/vomiting • Fatigue • Dizziness • Balance problem • Changes in vision • Sensitivity to light/ noise Cognitive • Feeling "foggy" • Feeling slowed down • Difficulty concentrating or remembering Sleep • Sleeping more or less than usual • Drowsiness • Hard to fall asleep/waking during the night Mood • Irritability • Anxiety • More emotional • Sadness • Nervousness BRAIN RESEARCH HITS A NERVE P erhaps you have heard someone talk about the “vagus nerve” and might have thought it pertained to how much cash you deigned to bring to the heart of Sin City. (If so, you would be wrong.) In fact, the vagus nerve is the body’s longest cranial nerve. It contains motor and sensor fibers and, because it passes through the neck and thorax on its way to the abdomen, it also has the widest distribution in the body. The vagus nerve controls the parasympathetic nervous system, which oversees a vast array of crucial bodily functions, including digestion and slowing the heart rate. To researchers at one of North Texas’ most prestigious universities, studies into the stimulation of the vagus nerve may help provide patients living with post-traumatic stress disorder (PTSD) and also those recovering from strokes with viable new treatment methods. Researchers at UT Dallas are exploring how mild stimulation of the vagus nerve could help alleviate symptoms of PTSD, a complex condition that can cause debilitating anxiety and mental anguish. Vagus nerve stimulation (VNS) is already used as a treatment for disorders including epilepsy and depression, and it has been shown to enhance memory retention. The technique’s effect on memory is key: UT Dallas researchers theorized it could help those with PTSD successfully learn to overcome fear responses in non-threatening situations. “Therapies currently in use for patients with PTSD include talk therapy and exposure therapy. They can work, but patients, understandably, don’t always adhere to those treatments because they don’t want to re-experience trauma,” Dr. Kilgard said. “We wanted to explore ways of making treatment better tolerated and more effective.” Dr. Kilgard noted that current improvements for those with PTSD may be short-lived, even if they faithfully adhere to current treatments. If they re-experience a trauma in their lives such as a death in the family, instead of having mild setbacks in PTSD symptoms, they typically lose much of their progress. “In our study, we found that VNS not only improved fear responses in non-stressful situations, but those improvements lasted even after another traumatic experience occurred,” Dr. Kilgard said. Even after VNS therapy was discontinued, it continued to help patients. “We were encouraged to find that after one week of no VNS treatments at all, there were still protective effects,” said Lindsey Noble, lead author of the study and a doctoral student at UT Dallas. The studies of VNS as a potential therapy for PTSD were supported by a $6.4 million grant from the Defense Advanced Research Projects Agency. Dr. Robert Rennaker is the grant’s principal investigator and director of the Texas Biomedical Device Center at UT Dallas. VNS is also being studied by researchers at UT Dallas for its benefit to patients who have experienced stroke, and one of its common consequences, chronic impairment of the arm and hand. Studies in animals have indicated that brief bursts of VNS, in conjunction with rehabilitative training, improve the recovery of motor function after a stroke. Researchers tested whether VNS could promote generalization, long-lasting recovery and the brain’s ability to change its physical structure in motor networks as a result of learning. The results showed a doubled long- term recovery rate relative to current therapy methods, not only in the targeted task but also in similar muscle movements that were not specifically rehabbed. Our experiment was designed to ask this new question: After a stroke, do you have to rehabilitate every single action? Dr. Kilgard said, “If VNS helps you, is it only helping with the exact motion or function you paired with stimulation? What we found was it also improves similar motor skills as well, and those results were sustained months beyond the completion of VNS-paired therapy.” Kilgard said the results provide an important step toward creating guidelines for standardized usage of VNS for post-stroke therapy. A clinical trial to test the technique in humans is underway in Dallas and 15 other sites across the country. “This study tells us that if we use this approach on complicated motor skills, those improvements can filter down to improve simpler movements,” he said. Lancaster Economic Development Shane Shepard msshepard@lancaster-tx.com 972.218.1314 The Doctors “We found evidence that treating the traumatic memory produced lasting improvements in other PTSD-like symptoms such as anxiety, arousal and avoidance,” said Dr. Christa McIntyre, associate professor of neuroscience in the School of Behavioral and Brain Sciences and the study’s senior author. To test the theory, researchers applied painless electrical stimulation to the vagus nerve in rodents with symptoms of PTSD. After receiving VNS, the animals showed diminished fear responses and increased social interaction, suggesting the treatment was effective in minimizing PTSD symptoms. If VNS provides the Chandramallika Basak, Ph.D. assistant professor of the Center for Vital Longevity at The University of Texas at Dallas Erin Reynolds, Psy.D., clinical director of the Sports Concussion Center at Baylor Scott & White Sports Therapy & Research at The Star Dr. Michael Kilgard, professor of neuroscience at UT Dallas and a study author SUMMER 2018 WWW.NTC-DFW.ORG 63