Functional MRI guides handling of concussions

A tipping point in every widely accepted technology occurs when some event nudges it from the periphery into the mainstream, setting it on a course for increasingly rapid adoption. Functional MRI may be reaching that point.

Scientific research into the workings of the brain has garnered a high profile for fMRI. Its value in planning the surgical treatment of patients with brain tumors also is gaining acceptance. Now comes word that fMRI may have another practical application that is well within the scope of everyday life.

Researchers at the University of Pittsburgh School of Medicine have linked changes in brain function directly to the recovery of young athletes who have suffered concussions.

"Functional MRI is providing insight for safe return-to-play decisions in young athletes and may help shape guidelines in the future," said Michael Collins, Ph.D., an assistant professor of orthopedic surgery and neurological surgery at Pittsburgh.

Between 1.4 and 3.6 million sports and recreation-related concussions occur each year. Most happen at the high school level, according to the Centers for Disease Control and Prevention.

Recent studies have shown that until a concussed brain is completely healed, it may be vulnerable to further injury. Much of this research has included data that prove the usefulness of objective neuropsychological testing as part of the comprehensive clinical evaluation to determine recovery following concussion.

The fMRI research at Pittsburgh documented the link between changes in the activation of certain brain regions and clinical recovery in concussed athletes. Recovery was defined as a complete resolution of symptoms along with neuropsychological testing results that fell within expected levels or matched an initial baseline.

The research involved 28 concussed high school athletes and 13 age-matched controls. The athletes underwent fMRI evaluation within approximately one week of injury and again when they met criteria for clinical recovery. During their fMRI exams, the athletes were given working memory tasks to complete while the brain's activity was observed and recorded.

As a group, athletes who demonstrated the greatest degree of hyperactivation shortly after their injury also demonstrated a more prolonged clinical recovery.

"Continued research designed to evaluate multiple parameters of concussion effects and recovery will help structure return-to-play guidelines," said Mark Lovell, Ph.D., an asssociate professor of orthopedic surgery and neurological surgery at Pittsburgh.