The latest in treatment for concussions – A Q&A with Dr. Robert Cantu, MD, Cantu Concussion Center

What is new in concussion diagnosis and treatment?

Two big things have emerged during the last few years. First, it is now widely acknowledged that concussion is treatable, and you do this by treating a patient’s silos of symptoms with appropriate therapy. Second, we now know that you don’t need to receive a concussion to wind up with problems if you’ve had enough sub-concussive trauma. Blows to the headcount, rather than just actual concussions. The goal is to reduce the number of times your brain is violently shaken and thus limit chronic traumatic encephalopathy risk later in life. This is why the NFL moved the kickoff to the 35-yard line—to reduce the number of injuries during the runback, which is the most dangerous play in football, and limit full contact only to during the season and, even then, less than once a week. We spend a good deal of time educating people. While it is true that no head trauma is good and should be avoided, people needn’t be paranoid about it. Individuals can take quite a bit of mild trauma without causing later-life ramifications. However, I’m glad to see the NFL and college football teams have changed the amount and kind of contact they allow during practice, and more flag football is available for our youth today. It took a long time to see that happen.

There has been notable growth since the Cantu Concussion Center opened three years ago.

Yes, thanks to the skilled, experienced staff that have joined us. They include additional neurologists—notably a pediatric neurologist— neuropsychologists and nurse practitioners. We have many therapists who specialize in concussion. In fact, I don’t know any other concussion center that has as many cognitive, ocular and vestibular therapists as ours. In terms of diagnosis, testing and treatment, we have all the options an individual might need, as well as unique technology. I’m very proud of what we’ve created together.

How specialized is the testing at the Concussion Center?

We conduct complex neuropsychological testing for individuals who have developed mood disorders—depression, anxiety or panic attacks—as well as cognitive problems. This is important, because we now have active therapies that we can direct at persistent concussion symptoms—those that last a month or longer—and make them go away much more rapidly. Anyone with such symptoms should see a concussion specialist who can provide this care.

Describe the clinical research underway at Emerson.

We have a long-standing interest in treating post-concussion syndrome (PCS), which occurs in 10-15 percent of adults who are diagnosed with a concussion. They experience persistent symptoms, which can be cognitive, physical or emotional. Our $1,025,000 grant from Oak Foundation is allowing us to conduct two pilot studies using Vasper, a recumbent bike that does two things: it provides cooling and restricts blood flow to the arms and legs, which results in the secretion of growth hormone. Our research indicates that individuals with PCS who receive Vasper therapy maintain symptom improvement better than those using a regular recumbent bike. Emerson is the only place in the northeast that has Vasper technology, and our patients benefit from this. Also, last spring Concussion Center staff published a pilot study in Health that suggests the addition of electrical stimulation to the standard physical therapy we perform on the neck has added benefits for individuals with PCS.

Are you optimistic about the future of treating concussions?

I’m hugely optimistic, partly because of the higher profile of the entire field—the improved understanding of what concussion is and how to treat it—including on the part of the public. We’ve seen the response by the government, which has provided increased funding for research. It’s an exciting time; research is at an all-time high, and emerging therapies are occurring. Ten years ago, we treated concussions with cognitive or physical rest and reduced activity until symptoms got better on their own over time. We’d say: “let the patient rest until those symptoms go away.” That’s a far cry from what we do today. We know that you should be as active as you can be without making symptoms worse.