Highlights in UF Concussion Research Michael S Jaffee

Highlights in UF Concussion Research Michael S. Jaffee, M. D. , Medical Director Russell M. Bauer, Ph. D. , ABPP, Neuropsychologist Breton Asken, M. S. , ATC Neurology Research Day January 22, 2017 University of Florida

The Team BRAIN CLINIC Michael S. Jaffee, MD, Medical Director Russell M. Bauer, Ph. D, ABPP, Neuropsychologist Zach Sutton, PT, DPT, Physical Therapist Kyle Platek, DRS, OTR/L Breton Asken, MS, ATC Molly Sullan, MS Gabrielle Altomare, MS Sarah Greif, BS RESEARCH COLLABORATORS Jay Clugston, MD, UF Team Physician Steven T. De. Kosky, MD Jon Boone, MS, ATC, LAT, FMSC, NCPT Dewayne Du. Bose, Ph. D, ATC, LAT, NCPT Zachary Houck, MS Joseph Gullett, MS David Fitz. Gerald, MD Thomas Mareci, Ph. D Michael Mc. Crea, Ph. D “Science, Practice, and Collaboration for Recovery”

UF BRAIN Clinic: Brain Injury Rehabilitation and Assessment INterdisciplinary Clinic • Opportunities for Shared Trans-Disciplinary Research • Sharing Measures and Techniques from Partner Disciplines Neurology • National Collaborations Neuropsychology Patient Occupation al Therapy Physical Therapy “Science, Practice, and Collaboration for Recovery” • On-Field / Acute Injury • Factors Affecting Symptom Recovery vs. Persistence • Factors Affecting Long-term Complications

Typical = 7 -14 days Acute Rest Athlete Reports Immediately Concussion Diagnose and Remove from Play Unrestricted Return to Play Cognitive and Physical Exertion as Tolerated

Typical = ? ? Athlete Delays Reporting Concussion Continued Physical Exertion Acute Rest Diagnose and Remove from Play Additional Blows to Head? Unrestricted Return to Play Cognitive and Physical Exertion as Tolerated

• Methods • 97 athletes dichotomized as “Immediate Removal From Activity” (I-RFA) or “Delayed Removal From Activity” (D-RFA) • Analyzed differences in days missed from athletic activity controlling for other recovery modifying factors • Sex, concussion history, LD/ADHD dx, psychiatric dx, and acute symptom severity • Findings • Delayed reporting athletes missed ~5 more days from athletic activity compared to immediate reporting • 2. 2 x more likely to have 8+ day recovery • First demonstration in humans of acute “window of vulnerability”

(Neuro)Psychology Neurology Physical Therapy Occupational Therapy Pain Management Social Work

Trans-Disciplinary Model Neuro. Bio. Psycho. Social Approach

Current Key Questions • Predictors of persistent TBI-related symptomatology • Does TB-induced sleep disturbance aid and abet chronic post-injury symptoms? • Mechanisms and clinical manifestations of neurodegeneration after TBI. • Can we improve neuropsychological characterization of post-injury cognitive status • Using helmet sensor data to monitor and characterize impact history in NCAA athletes (Clugston)

Segmentation of LC using FLOCS Collaboration with Tom Mareci, Ph. D. Sullan MJ, Bohsali AA, Gullett JM, Goldstein J, Bauer RM, et al. (2014) The Locus Coeruleus and Sleep-Wake Disturbances in Veterans with m. TBI. J Sleep Med Disord 1(1): 1004. Resolution of LC-Hypothalamic tracts using MOW Tractography

The Vision: Genome-to-Syndrome Model for TBI

• Delayed reporting athletes missed ~5 more days from athletic activity compared to immediate reporting • 2. 2 x more likely to have 8+ day recovery • First demonstartion in humans of “window of vulnerability”