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Biomarkers to diagnose concussions
In most contact sports such as rugby, football, ice hockey, and boxing just to mention four of the most popular contact sports, concussion represents a great challenge to players and sports. However, concussions are also experienced in non –sports environments such as during falls or accidents. Concussions can lead to a variety of health conditions including chronic encephalopathy, post -concussion syndrome, mild cognitive impairments and in worst-case scenarios death. In other words, without prompt address of concussions, the consequences of concussions can be fatal.
Thesis: Using biomarkers to diagnose concussions in players can make the health of the players safer and improve the treatments of concussions in general.
Concussion applies to a sophisticated pathophysiological brain injury, which causes disturbances to the brain, and one that is caused when an individual receives a blow directly in the head or when there is indirect movements that result in extreme shaking of the head (Sports Concussion Institute, 2014). Annually, about 1.6 -3.8 million sportsmen are reported to experience concussions in their sports (Sports Concussion Institute, 2014). Nearly 5-10% of sportsmen are also likely to experience concussions in a particular sports season. It is also estimated that 78% of concussions are experienced when the game is being played and not after the game has been played (Sports Concussion Institute, 2014). As aforementioned, concussions also occur in non-sports related environments through accidents and falls although it is predominant in sports. Presently, concussion diagnosis takes place in a clinical manner. As such, there is no particular test used to establish whether a person has suffered a concussion or not. By using biomarkers to determine concussions, it will be possible to help players from risking their lives when they experience concussions while the treatment of concussions as brain injuries will also be improved.
In recent times, several studies have been conducted to establish the possibility of using biomarkers as a way of diagnosing the concussions experienced by players in the field. According to a study done by the University of Saskatchewan, scientists have been undertaking studies to develop ways in which concussions can be identified through the use of small blood drops (Sheridan,2014). The researchers collected plasma samples of volunteers and established the normal quantities of plasma proteins. This was then compared with plasma samples from players who had experienced concussions when playing (Sheridan, 2014). The research findings indicated that the identical proteins showed higher levels when there was concussion. The researchers made the inference that the protein biomarkers could be utilized to identify or isolate concussions in the patients (Sheridan, 2014). The researchers also observed that the protein biomarkers can be wildly used in the detection of concussions granted that concussions are experienced differently among individuals (Sheridan, 2014). The researchers also extended the research to go beyond sports and include the concussions also suffered by children. The objective of developing the kit to detect concussion biomarkers is to facilitate the early detection of concussions in players or those who may experience concussions as a result of other injuries (Sheridan, 2014) . Another study done in Sweden also generated similar results. Shahim et al (2014) conducted a study in Sweden where 288 hockey players were investigated for the presence of biomarkers. Among the participants, 28 of them had experienced concussions. The researchers found that the t- tau proteins in the samples of the participants following concussions was 10 pg/ML and 4.7 pg/mL in samples taken from some other players during the preseason (Shahim et al, 2014). The researchers observed that two other potential biomarkers; the neuron specific enolase and the S-100B proteins did not generate the same results (Shahim et al, 2014). When compared to the S-100B proteins, the levels of S-100B increased following a concussion and by the end of day 6, the levels of the proteins had been reduced to normal (Shahim et al, 2014). On the other hand, the levels of t-tau proteins increased following concussions and then remained steady in the concussed participants. This finding demonstrated that the t-tau proteins acted as an effective biomarker for proteins than the S-100B proteins (Shahim et al, 2014). This also implies that t-tau protein represents a potential biomarker towards the identification of concussions in players (Shahim et al, 2014). According to the findings of the study, concussions result into the release of certain proteins such as t-tau and these proteins can be used to help in the detection of concussions (Shahim et al, 2014). Additionally, the researchers also remarked that the total t-tau proteins could also be used to make predictions on the constant symptoms of concussions experienced by some players. The findings of the study thus increased the possibility of using proteins to act as biomarkers towards the identification of concussions (Shahim et al, 2014). Through the findings of the study, the researchers also concluded that the t-tau proteins can be used to help in the determination of concussions severity. The more the levels of t-tau proteins are circulating in the blood following a concussion, it is also an indication that the individual is facing severe concussions (Shahim et al, 2014).
Siman et al (2014), performed a study that found blood tests could be used to establish whether a player should be rested or returned to the field following an injury to the head. The study established that following brain injury, the serum levels of calpain-derived alpha-spectrin N-terminal fragment also known as the SNTF increases (Siman et al, 2014). A big blow to the head induces chemical transformations inside the nerve cells that cause damage to their proteins. The researchers followed a group of 20 ice hockey players who had experienced concussions in their playing times and the concussion symptoms persisted for 6 days or over (Siman et al, 2014). The SNTF blood levels were found to be higher in these groups of players when compared to the protein level fragments in another group of 8 players who suffered concussions that persisted only for 5 days or less (Siman et al, 2014). At the same time, the levels of SNTF were also found to be lower among 45 non-concussed players during the preseason. Based on the findings of the study, the researchers concluded that a blood test aimed at detecting SNTF could be used to estimate the recovery time required following an injury to the brain (Siman et al, 2014). Secondly, the researchers also observed that when combined with other tests of neurology, the serum levels of SNTF molecules could also be utilized by doctors towards the estimation of players safety when they suffer brain injuries (Siman et al,2014). This study also confirms the importance of biomarkers as means of identifying concussions. Similarly, Pham et al (2015) have also identified a plasma soluble prion protein that can be used as a biomarker to identify and facilitate the treatment of concussions. In the pilot study undertaken at the University of Saskatchewan , the researchers recruited both sportsmen and non- sportsmen aged between 18-30 years old. 65 participants were recruited from the high contact sports such as wrestling, football, basketball, and soccer (Pham et al, 2015). Samples were also obtained from participants in low contact sports such as athletics and volleyball while for the normal values; samples were obtained from 27 non-sportsmen (Pham et al, 2015). The researchers observed that the plasma soluble cellular prion protein designated as PrPc increased in concussed sportsmen and could be used as a biomarker for concussion (Pham et al, 2015).
In one of the more recent studies, a team of researchers at Brown University isolated a set of four proteins that are detected in blood readily and can be used to detect concussions (Orenstein, 2015). By examining the molecular consequences of concussions through innovative ways, the researchers were able to identify the proteins in ways that are different to the ones usually used (Orenstein, 2015). Previously, studies that have been used to identify proteins that can be used to detect concussions have predominantly relied on proteins generated by dying brain cells. In their study, the researchers analyzed proteins that are produced in reaction to brain injury and then released into the bloodstream (Orenstein,2015). Using information done previously on animals, the researchers highlighted four proteins to wit; occludin, matrix metalloproteinanse 9, galectin 3, and copeptin (Orenstein, 2015). The researchers observed dramatic changes in these proteins following incidences of concussions. In addition, two proteins of occludin and galectin 3 also showed the capacities to distinguish patients who had experienced concussions from their counterparts who had suffered other types of orthopedic injuries like bone break (Orenstein, 2015). In this sense, the proteins could also be used to separate concussions from other type of injuries with similar symptoms to concussions. Although an injured individuals could also have elevated levels of one of the four proteins, the study found that they did not have high levels of two or more of the proteins simultaneously (Orenstein,2015). On the other hand, 90% of the patients who experienced concussions had substantial changes in the levels of one or two proteins identified as potential biomarkers (Orenstein, 2015). When the researchers examined at an aggregate of the three distinctive proteins, they detected critical changes in the serum levels of the three proteins that offered high sensitivity and specificity in relation to brain injury when compared to the patients who did not have the brain injuries (Orenstein, 2015). Although the individual proteins were also substantially changed in the patients who suffered from bone breaks as in the situation of occludin, the researchers established that it was only in the concussed patients that there was a correlation between the high levels of galectin 3 and high levels of occludin (Orenstein, 2015). This way, the four proteins in their entirety can be used to diagnose concussions that result from brain injury as the principal problem as well as concussions that may result from injuries in other body parts (Orenstein, 2015). The four proteins were also found to be consistent in patients who experienced brain injuries despite their age, gender, as well as other medical conditions that may be experienced by patients(Orenstein,2015). This means that the proteins increased in situations where individuals experienced concussions.
In essence, using proteins as biomarkers to diagnose concussions can improve the safety of players as well as patients who may suffer concussions from other injuries. From the results of the studies conducted, it is apparent that biomarkers will significantly help to determine when players can be released back to the field of play without much risks. In the same vein, the biomarkers can be used to help in distinguishing concussions that arise from brain injuries and concussions that may be induced by injuries from other parts of the body. All in all, using biomarkers to diagnose concussions will be a great medical step.
Orenstein, D. (2015, March 25). Brown University. Retrieved April 4, 2015, from https://news.brown.edu/articles/2015/03/concussion
Pham, N., Akonasu, H., Shiskin, R., & Taghlibighlou, C. (2015). Plasma Soluble Prion Protein, a Potential Biomarker for Sport-Related Concussions: A Pilot Study. PLoS One, 10(2), 1-12.
Shahim, P., Tegner, Y., Wilson, D., Randall, J., Skillback, T., Pazooki, D., . . . Zetterberg, H. (2014). Blood Biomarkers for Brain Injury in Concussed Professional Ice Hockey Players. JAMA Neurology, 71(6), 684-692.
Sheridan, M. (2014, August 18). Biomarker research could help improve early concussion diagnosis. Retrieved April 4, 2015, from http://www.medicine.usask.ca/news/2014/research-could-improve-early-concussion-diagnosis.php
Siman, R., Shahim, P., Tegner, Y., Blennow, K., Zetterberg, H., & Smith, H. (2014). Serum SNTF Increases in Concussed Professional Ice Hockey Players and Relates to the Severity of Post-Concussion Symptoms. Journal of Neurotrama.
Sports Concussion Institute. (2014, January 1). Concussion Facts | Sports Concussion Institute. Retrieved April 4, 2015, from http://www.concussiontreatment.com/concussionfacts.html