As part of the weekly BME seminar series, Dr. Thomas Talavage gave a guest lecture on his research involving the study of concussions, CTE, and head injuries.

Chronic traumatic encephalopathy, more commonly known as CTE, is a dangerous brain disease caused by repeated concussions or hits to the head. In this day and age, it is inevitably associated with sports, especially at the youth level. There is no doubt that CTE is a harsh or even fatal condition with heavy ties to activities like football, but the amount we know about the disease is surprisingly little. CTE was first discovered in ex-NFL players in 2005 and only became widely publicized around 2009. Much of the knowledge about it is still a work in progress, and the precise causes of CTE, and consequently, the ways to defend against it, are still unknown. It is a complex issue that some neuroscientists, biomedical engineers, and other specialists are attempting to tackle to this day.

Dr. Thomas Talavage is one of those people. As a professor and head of the biomedical engineering department at the University of Cincinnati, he has worked for years on the study of head injuries and concussions, using his electrical engineering and artificial intelligence experience to help achieve this goal. Last Friday, Talavage came to Columbia University as part of the weekly BME seminar series, held in Schermerhorn Hall, to discuss his research and its implications.

To begin the talk, the professor introduced the idea of “asymptomatic injury.” This is a concept that is not unique to healthcare—airplanes can break due to design issues causing a buildup of microfractures, and power grids can be brought down if their operations rely on a single line. An injury, in Talavage’s case a blow to the head, impairs the delivery of neurological inputs in their proper intervals. However, detectable symptoms will not occur until the inputs fail completely and information is not transferred. Consequently, an injury can occur and cause brain damage, but not until the damage is often irreparable will the subject experience any symptoms.

So without symptoms, how is it possible to assess the player in question? Over his 11 years of research, Talavage gathered and examined a wealth of subjects: 12 teams, 660 players, and over 2200 scans conducted. In this period, he mainly used a system he described as “structural health monitoring.” He would gather data on each player prior to the season, and then use non-destructive forms of evaluation multiple times throughout the season. Afterward, comparisons could be used to differentiate the “healthy” and “impaired” players. Talavage soon found that although the magnitude and location of hits were undoubtedly important, the number of impacts was by far the most relevant factor. Although this is now unsurprising information, Talavage was one of the first scientists to obtain data that supported this conclusion and revealed its effects.

The conclusions from these earlier papers were unprecedented. The professor found that at younger levels of football, although forces from impacts were less, the accelerations of the players’  heads differed much less. In the same vein, although the total number of hits did vary by level and sporting discipline, the frequency of those hits varied much less (as younger athletes typically have shorter seasons, it takes fewer hits to have a high consistency). These results were extremely worrying. Not only was CTE becoming increasingly evident to be a major problem, but clearly its causes could be drawn back to the players’ very early ages. Talavage also noted in the talk that many of the prevention systems implemented both back then and currently, such as head impact telemetry, were often inaccurate and unsafe.

With these initial conclusions, Talavage became well-known in the field, and even wrote a Sports Illustrated article in 2010 revealing that the accumulation of minor hits could be equal to or worse than a major concussion. He continued to gather data over the next decade, refining his research and attempting to determine the precise effects of head injuries. With the huge number of MRIs that were conducted on the players, Talavage further discovered that connectivity in the brain decreased over the course of a football season, but especially quickly during the preseason. He hypothesized that this was due to a lack of breaks.

Through the analysis of his players, he also saw that the subjects’ self-identifiability (their ability to perceive themselves) also decreased as the season progressed. This continued research only served to reinforce the dangers of football and the terrifying nature of CTE. He is continuing this research, now looking at the biomarkers, DNA, and physiology of patients. Early results are indicating that mitochondrial distress in cells has a potential correlation to head injuries and CTE.

In addition to his research on the disease itself, Talavage wanted to apply his results to the world. As a dedicated sports fan and former athlete himself, his ultimate goal was to answer the obvious question. Can we prevent injury? His current projects focus on attempting to reduce the accumulation of brain tissue damage in athletes through three methods: improved training, metering of exposure, and improved equipment. 

The first of the methods, technique, Talavage tested in a collaboration with Stanford University. He tested the effect of moving away from “traditional” stances and starting positions, such as the three-point stance. These positions, which are designed for speed, also encourage players to tackle head-first, leading to a faster accumulation of hits. Talavage devised a modified stance, keeping the same speed but minimizing the danger of head impacts, and tested it with the Stanford players. Encouragingly, it was highly successful and significantly reduced hits. However, this effect was more prevalent the more experienced and skillful the player was—most likely due to an easier time adapting. Talavage is currently testing similar technique modifications with wheelchair athletes, a group in which injuries can highly impact players’ daily lives.

Talavage’s second method was exposure metering, which he examined in a simple and concise way. Working with high school players, he took data on the head hits taken by players during every practice and provided that to the coaches. This allowed the coaches to design future schedules around this data. For example, if there was ever an excess of head hits in one practice, the coaches could lighten the schedule for the future. Talavage is attempting to improve this method by getting individual head measurements for better and more complete data.

The last of the methods was improving player equipment and is still a work in progress. Throughout his research, Talavage found that current helmets do not function well, especially at youth levels. Additionally, because a concrete safe exposure limit is not known, the standards for helmets are lax and inconsistent. The professor is attempting to find funding for testing improved youth helmets, especially those that provide sufficient protection from hits from the back, a factor all modern helmets are still weak toward.

After concluding his talk, Talavage revealed several more interesting facts about his research in the subsequent Q&A session. He discussed his plans to do more longitudinal data studies in the future, once long-term controls are established. The professor also noted that more sports should be considered to be collision-based, most notably diving and volleyball, which have a deceptively high amount of hits to the head. Further elaborating on helmets at youth levels, Talavage mentioned that due to the fact that young athletes often have nearly adult-sized heads but much smaller bodies, accelerations on their heads are much higher than what initially might be suspected.

Although his research can not yet be completely linked and interconnected with CTE, as the time scales for the brain disease are simply too large, Talavage hopes that his studies are leading us down the right road—one where we will eventually be able to thoroughly protect athletes and make sports safer than ever before.

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