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Uniformed Services University Joins CARE Consortium

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DoD and NCAA add $22.5 million in funding for World’s Most Comprehensive Concussion Study

Uniformed Services University of the Health Sciences has joined the Concussion Assessment, Research and Education Consortium (CARE), a partnership between the Department of Defense (DoD) and the National Collegiate Athlete Association (NCAA).  The CARE Consortium is the world’s most comprehensive concussion study.

The CARE Consortium was established as part of the broader NCAA-DoD Grand Alliance in 2014, with the goals of understanding how concussions affect the brain and identifying ways to improve diagnosis, treatment and prevention.

Led by Indiana University School of Medicine, the University of Michigan and the Medical College of Wisconsin, and now in collaboration with USU, the study has collected data on more than 39,000 student-athletes and cadets at 30 colleges and military service academies -- including more than 3,300 who have experienced concussions. This represents the largest sample of concussions ever researched in a single study.

The DoD and NCAA announced Oct. 31 that they were providing $22.5 million in new funding for the study to examine the impacts of head injuries over several years.  The NCAA is providing $12.5 million in funding over two years for the second stage of research. The DoD approved a two-year grant of nearly $10 million.

The initial phase of the study -- made possible by a joint NCAA-DoD grant of $30 million -- focused on the acute effects of concussions by evaluating concussed participants with a sequence of clinical and advanced research tests in the immediate hours, days and weeks after the injury, and comparing the results with baseline tests administered at the start of the study.

The new phase will include comprehensive testing of the participants when they leave college and up to four years after their collegiate sports or service academy career has ended. This expanded approach will enable researchers to study the intermediate and cumulative effects of concussion and repetitive head impact exposure. Importantly, researchers hope to differentiate between the effects of concussion, repetitive head impact, and sports participation with no history of either concussion or repetitive head impact exposure.


"We have gathered important information about the short-term effects of concussions over the past few years, but there is still a lot we do not understand about how our brains respond to different types of impact over time," said Dr. Thomas W. McAllister, chair of the Department of Psychiatry at Indiana University School of Medicine and the leader of the study's administrative and operations center. "By comparing these groups across multiple years, we think we can parse out the effects of concussions, versus repetitive head impacts, versus normal life at university. This is critical for us to make informed decisions that protect our athletes, members of the military and other members of our communities."

The evaluations will include clinical tests to assess attributes such as balance and memory but also will probe changes to participants' psychological health to determine what role, if any, concussions and repetitive head impacts may have on depression, anxiety and emotional control. Researchers also will continue to conduct advanced research tests, including genetic analysis, brain imaging and blood tests to measure biomarkers associated with inflammation and nervous system dysfunction. It is conceivable that the advanced research tests will help identify genes and other objective markers that render an athlete or cadet more or less susceptible to concussion or injury from repetitive head impacts.

"This new phase of funding represents a critical extension to the original study goals, allowing us to take an unprecedented look at cumulative and persistent effects of concussion and repetitive head impact exposure," said Dr. Brian Hainline, NCAA chief medical officer. "What we learn from this research will advance the science of traumatic brain injury and improve our understanding of how to best support the health and well-being of student-athletes, not only during their collegiate athletics experience but beyond."

Dr. Paul F. Pasquina, a retired Army colonel, professor and chair of the Department of Rehabilitation Medicine and director of the Center for Rehabilitation Science Research at USU, joined the CARE Consortium as USU’s representative.  His role is to promote and facilitate the involvement of the four military service academies in the consortium.

"Traumatic brain injury and its effect on the health of our service members is not only of high concern to the military, but to those providers who have been entrusted with their care. Our team at USU is very humbled to be able to work closely with all four of the U.S. Service Academies (West Point, Air Force, Coast Guard, and Navy) in partnership with the NCAA on this unprecedented large-scale research effort.  We are also grateful to the DoD and NCAA leadership for recognizing the importance of this study not just for the military or NCAA, but for the nation," said Pasquina.

The CARE Consortium is overseen by principal investigators at research institutions. Indiana University School of Medicine serves as the administrative and operations core and is the central coordination center for the CARE Consortium. Led by Dr. Thomas W. McAllister, chair of the Indiana University School of Medicine Department of Psychiatry, the Indiana team provides regulatory and fiduciary oversight, as well as as biostatistics and data management, neuroimaging, bioinformatics, biomarkers/biospecimen management, and other support resources for the consortium.
The University of Michigan leads the longitudinal clinical study core, a prospective, multi-institution clinical research protocol studying the natural history of concussion among NCAA student-athletes and military service academy cadets. Steven Broglio, Ph.D., professor of kinesiology and director of the Michigan Concussion Center at the University of Michigan, leads this effort.
Michael McCrea, Ph.D., professor of neurosurgery and co-director of the Center for Neurotrauma Research at the Medical College of Wisconsin, directs the advanced research core, which includes head impact sensor technologies, advanced neuroimaging and biological markers that include detailed genetic testing.
Uniformed Services University coordinates engagement with the four military academies in the consortium. Retired Army Col. (Dr.) Paul F. Pasquina, professor and chair of the department of rehabilitation medicine and director of the Center for Rehabilitation Sciences Research, leads this aspect of the study. (Map and caption are courtesy of the NCAA-DOD Care Consortium)

"Optimizing the health and performance of our warfighters is paramount to enhancing the readiness and lethality of the force," Terry M. Rauch, acting deputy assistant secretary of defense (Health Readiness Policy and Oversight), said regarding the DoD’s participation in the study. "Traumatic brain injuries are a major readiness concern as our warfighters are particularly susceptible to these injuries during combat and training. The department is leading efforts in research to better understand how to prevent, diagnose and treat TBIs across the range of military operations. However, much more work needs to be done, and this partnership with the NCAA and participating academic institutions provides valuable evidence to optimize the health and performance of our warfighters."

Other study leaders include:
Steven Broglio, professor of kinesiology and director of the Michigan Concussion Center at the University of Michigan. Broglio leads the longitudinal clinical study core, which oversees all clinical aspects of the study.

Michael McCrea, professor of neurosurgery and co-director of the Center for Neurotrauma Research at the Medical College of Wisconsin. McCrea leads the advanced research core, which includes head impact sensor technologies, advanced neuroimaging and biological markers that include detailed genetic testing.

Indiana University School of Medicine, under the direction of McAllister, which provides regulatory and fiduciary oversight, as well as biostatistics and data management, neuroimaging, bioinformatics, biomarkers/biospecimen management, and other support resources for the consortium. Indiana University School of Medicine partners with the Datalys Center and QuesGen Systems in this effort.
Already, the CARE Consortium has generated information related to important topics such as the impact of removing student-athletes from play after a concussion; the influence of age at the time of first concussion; sleep and concussion recovery; and tools and tests used to assess concussions. A list of the scientific publications resulting from the CARE Consortium study may be found on the NCAA Sport Science Institute website.