Honoring Scientific Leadership in an Era of Change
By Jeffrey S. Kutcher, M.D.

Viewpoints presented in SMB commentaries reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM.

Dr. Kutcher is Director of the Michigan Neurosport Program and a Clinical Associate Professor of Neurology with the University of Michigan Health System in Ann Arbor. His research focuses on the neurologic aspects of sports injuries, particularly related to concussion, migraine and sleep disorders. He is a leader is sports neurology and recently was appointed to direct the National Basketball Association’s new Concussion Program. His statement below was extracted and adapted from his recent commentary, which appears in the May-June 2012 issue of Current Sports Medicine Reports (CSMR).

Dr. Guskiewicz recently was named a 2011 MacArthur Fellow, an internationally prominent award, for his work in sport concussion. He is the Kenan Distinguished Professor and director of the Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center at the University of North Carolina at Chapel Hill. He also serves as the chair of the Department of Exercise and Sport Science and holds joint appointments in the Department of Orthopaedics, University of North Carolina Injury Prevention Research Center, and Doctoral Program in Human Movement Science. For 17 years, Dr. Guskiewicz has focused his research on sport-related concussion in high school and collegiate athletes. The range of his investigations has encompassed such issues as consequences of sport-related concussion on balance, neuropsychological function, and the long-term neurological issues. He has received 20 funded research grants and published more than 75 journal articles on these topics. He currently holds memberships on the National Collegiate Athletic Association’s Concussion Committee, the National Football League Players Association’s Mackey-White Committee, and the National Football League’s Head, Neck, and Spine Committee. Dr. Guskiewicz’s work in sport-related traumatic brain injury was recently profiled in the May-June 2012 issue of Current Sports Medicine Reports (CSMR), along with a statement of historic perspective and tribute by Dr. Kutcher.

SMB is pleased to share with our readers some of Dr. Guskiewicz comments from that profile article in CSMR. SMB join’s Dr. Kutcher in congratulating Dr. Guskiewicz for his persistent focused efforts, creativity, and leadership in advancing the understanding of concussive injury in sports - and this prestigious honor he has received from the MacArthur Foundation. For more, see The MacArthur Foundation.

Dr. Kutcher’s Perspective on TBI in Sport & Dr. Guskiewicz’s Research. Unlike the catastrophic injuries seen in football in the early 20th century, the diagnoses under intense scrutiny today that constitute the spectrum of brain injury that may occur are steeped in the unknown. Compared with the rather obvious pathologic mechanisms of skull fracture and hemorrhage, the diagnoses of concussion, chronic traumatic encephalopathy, and second impact syndrome are not well understood and are very difficult to study. The incredible complexity of brain physiology, the lack of objective testing for concussion, and the wide range of normal brain function within a population all combine to make this issue one of the most vexing in clinical medicine today. As such, the need for well-performed clinical science has never been more critical.

Over the past decade, we have witnessed an explosion in sports concussion research, efforts that continue to move the science forward and improve our understanding of both the short-term and long-term consequences of playing contact sports. Despite this, we still have relatively few data to help us accurately estimate the true risks. Although our media and legislative bodies look to construct a simple narrative, one does not exist in the scientific literature. While our patients and their families look for concrete answers and data-driven advice, both continue to be well out of reach.

As a field, sports medicine strives to understand the mechanisms of injury. Its foundation is the application of basic science toward a better understanding of human performance, while it is driven by the quest for data that accurately describe varying clinical outcomes. What happens when the basic science required to understand fully a particular aspect of human performance and injury simply does not exist to any significant degree? In the end, we must acknowledge that our most important role is to advocate for the well-being of our patients. Oftentimes, we are forced to make decisions based more on our collective clinical experience than on solid basic science. Given this, the need for critical thinkers experienced in the clinical practice of sports concussion is paramount.

Unfortunately, there is no easy answer or protocol-driven paradigm for diagnosis or management. To understand reasonably these injuries to the brain, the most complex and dynamic biological system imaginable, requires careful and meaningful discourse, rigorous dogged research, and, most importantly, a sense of humility and awe. In the nearly 20 years that Kevin M. Guskiewicz, PhD, FACSM, has been contributing to the field, he has displayed all of these attributes and more. He has provided not only critical thinking but also novel approaches to complex problems. He has been a leader in his field of athletic training and an inspiration to researchers and clinicians from every walk of life. As the science of sports concussion continues to unfold, only then may we truly begin to appreciate the contributions he has made to the well-being of the millions of athletes who have participated or will participate in contact sports.

SMB’s Q&A Interview with Dr. Guskiewicz: How did your interest and research in sports concussions evolve?

Dr. Guskiewicz: I was studying balance and postural control at the University of Virginia as a doctoral student when I realized I needed a condition in which to apply the objective balance tests. My advisor (David H. Perrin, PhD, FACSM) had just attended a concussion summit and suggested that I consider applying it to concussion as an objective measure of readiness to return to play. Given that I had worked as a graduate assistant with the Pittsburgh Steelers prior to beginning my doctoral work and I always was perplexed by the arbitrary nature in which players often were returned following concussion, I saw this as a natural fit.

SMB: How do you see the current landscape and progress with sports concussions?

Dr. Guskiewicz: The landscape is changing quickly. A culture shift has been set in motion at every level of play, and the state concussion laws are creating an awareness around concussions that ultimately will V in combination with the excellent research being conducted nationwide V save lives.

SMB: What do you think would make the most difference in preventing, diagnosing, and managing mild traumatic brain injury?

Dr. Guskiewicz: We need to educate parents, coaches, and athletes about the dangers of mismanaging concussion, and this all starts with ensuring that they understand the signs and symptoms of concussion and the importance of reporting these symptoms if they occur. In addition, we cannot rely on a quick fix such as a helmet to prevent concussive injuries. They do a great job of preventing catastrophic brain injuries but cannot manage totally the energy inside the skull to prevent concussions. Behavior modification, so as to minimize head contacts, must be considered in this equation to reduce concussions. Finally, we need to stay the course on trying to find interventions to treat concussions once they occur. There are several proposed therapies or interventions that may have promise but have not been researched adequately to prove their efficacy.

SMB: MacArthur Fellows each receive $500,000 in no-strings-attached support during the next 5 years. How do you plan to use this monetary award from the MacArthur Foundation?

Dr. Guskiewicz: A significant portion of the award will be turned back into our research at the Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center. I hope to receive matching funds from a variety of foundations interested in funding our work, and part of these investigations will extend beyond sport-related concussion and move into helping our U.S. military better understand the prevention and treatment of concussion.

Editor’s note: Dr. Guskiewicz will participate in a panel discussion, along with Dr. Sanjay Gupta and Dr. Margot Putukian, following a screening of the CNN documentary “Big Hits, Broken Dreams” on Wednesday, May 30 at the Annual Meeting. 5:45-7:00 p.m., Room 2016, Moscone West Conference Center, San Francisco.