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
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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.
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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
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