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Military Health System

Tackling Concussions: NCAA-DOD CARE Consortium Battles Brain Injuries

Image of Naval Academy football team runs onto the field . The U.S. Naval Academy football team runs onto the field during the annual Army-Navy football game held at MetLife Stadium in East Rutherford, New Jersey, Dec. 11. Navy student-athletes are part of an ongoing concussion study being conducted by the joint NCAA-DOD CARE Consortium (Photo by Navy Chief Petty Officer Diana Quinlan, Navy Recruiting Command).

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At colleges and universities across the country, there are nearly a half million student-athletes competing in National Collegiate Athletic Association sports during any given year.

As the NCAA often reminds its fans: "Most of them will go pro in something other than sports."

For a small cross section of college athletes from the four military service academies, they know exactly what they're "going pro" in – after graduation, they will become officers in the U.S. military.

Since 2014, the Department of Defense and the NCAA have been working together as part of the NCAA-DOD Concussion Assessment, Research and Education (CARE) Consortium, which brought over thirty colleges and universities together, including the four military service academies, to conduct the largest research study of its type to better understand the effects of concussions and repetitive head impact exposure on the brain health of student-athletes.

"To date, the CARE consortium has enrolled over 50,000 student athletes, with nearly 6,000 sustaining a concussion. By following these individuals before and after injury, researchers within the consortium have been able to advance our scientific knowledge of brain injury and the factors that influence outcomes," said Dr. Paul Pasquina, chair of the Department of Physical Medicine and Rehabilitation at the Uniformed Services University of the Health Sciences and chief of the Department of Rehabilitation at Walter Reed National Military Medical Center.

Pasquina recently discussed CARE along with Dr. Terry Rauch, director of medical research and development at the Office of the Assistant Secretary of Defense for Health Affairs, and NCAA Chief Medical Officer Dr. Brian Hainline on the NCAA's podcast "Social Series."

Surprisingly, Rauch said, data shows that many service members' head injuries actually occur in situations outside of combat.

"With respect to head injuries within the military, not only do we think about the deployed force, such as in Afghanistan and Iraq, but a lot of our head injuries occur in garrison or in training," he said. This includes contact and non-contact sports and off-duty accidents.

Pasquina, a former West Point football player, said the study holds a personal meaning to him. "I sustained several concussions myself, as did many of my classmates," he said, "and now as a physician, caring for individuals with brain injury, I remain very committed to optimizing the care for these patients."

"Since 9/11, I've had the privilege, but also the responsibility, of taking care of numerous service members who have sustained blast-related brain injuries, as well as impact-related brain injuries."

Distinguishing between the two types of head injuries can become difficult, as many happen in combination. Moreover, according to Pasquina, "many of the service members that sustain a blast injury have a prior history of playing contact sports or even sustaining previous concussion."

Through the CARE partnership, the DOD and NCAA have gained a better understanding of the biological and the physiological effects of concussions, the symptoms they present and the natural course of recovery.

CARE is the first major concussion study to assess both women and men, across 24 sports. Prior to CARE, most concussion literature came primarily from men's football and men's ice hockey. Leveraging an extensive infrastructure and experienced research team, the consortium has published more than 80 scientific papers advancing the science of mild traumatic brain injury, concussions and head impact exposure.

Pasquina's role has involved coordinating engagement at the four military service academies. During the next phase of the study, this engagement will expand to the military's Explosive Ordnance and Disposal school at Eglin Air Force Base, as well as the Defense Health Agency's National Intrepid Center of Excellence for TBI and Intrepid Spirit Centers at Fort Hood, Fort Bragg, and Joint Base Lewis-McChord.

"For the Department of Defense and for the NCAA, it's all about protecting and promoting the health of our service members and student-athletes, both during and after their time of service or athletic careers," Pasquina said.

"We really care about the health of our young men and women who are wearing the uniform and defending this nation," he said. "And on the NCAA side, they really do care about the health and welfare of their athletes, not just for the short-term while they're at the university, but for the long-term as well."

The improved understanding of head injuries has reduced the traditional tendency to tell athletes to push through a potential concussion, or for the athletes themselves feeling that they should.

"Everybody recovers at a different rate, and while the majority of individuals will have their symptoms resolve within one to two weeks, up to 20% many have persistent symptoms beyond 28 days, which needs to be more widely recognized," according to Pasquina.

"Over the past several years, there's been a real paradigm shift in the care of individuals with brain injury, and we hope that the knowledge gained from this study will help inform service members and athletes at all levels, whether playing varsity sports, club sports, or at the high-school or 'pee-wee' level," Pasquina said.

Due to this collaboration, the military and sports medicine communities have worked together in developing concussion care protocols.

"Dr. Hainline has done a ton of work, informing leadership throughout the NCAA including coaches, about the risks, mitigation strategies, and treatments involving concussion, and we have done the same thing on the military side by educating not only our providers, but squad leaders, company commanders, and military commanders across the DOD," said Pasquina.

Ideally, future military leaders currently attending service academies and involved in this study will be able to recognize concussions among the ranks.

"Being involved in this concussion study makes them aware of the importance of recognizing concussion in the soldiers, sailors, airmen and marines that they will lead in the future, so we really think it has a stronger impact than just the science," said Pasquina.

Rauch said he hopes the CARE study opens the door to further collaboration.

"There are so many other things that we can do with the NCAA and, through mechanisms such as the CARE consortium, we could also begin to look at other things, such as lifestyles and performance, diet and nutrition, and sleep hygiene. These are things that have a shared interest among our military and NCAA leaders," Rauch said.

Data from the consortium's findings will be made available to the broader scientific community to promote further development of specific strategies for injury prevention, early recognition, and mitigating treatments of those at greatest risk of brain health effects.

You can watch or listen to the full interview on the NCAA Social Series webpage. Click on "Episode 85: DOD CARE Consortium" to watch or listen on various platforms.

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