CDC national surveys find that the prevalence of concussions is dramatically higher than previously estimated (6/19/25 Newsletter)
This week, our lead article, CDC national surveys find that the prevalence of concussions/TBIs is dramatically higher than previously estimated, is in the Statistics category.
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In this newsletter: Opportunities, Annual Impact Report, Pathophysiology, Diagnostics, Statistics
Writers: Josh Wu, Ella Webster, Malayka Gormally, Conor Gormally
Editors: Conor Gormally & Malayka Gormally
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Opportunities
Wednesday, June 25, 4:30 pm EST: A free concussion group learning session, Recap of Key Principles & Assessment of Emerging Evidence, is offered for healthcare professionals and includes case presentations. These sessions are produced by the ECHO project at University Health Network in Toronto. Register for the June 25 session or the new series starting in September. Contact Keren.Sedmina@uhn.ca with questions.
Wednesdays starting July 9, 11–12:15 pm EST: A free, virtual program, MindSet for Veterans, provides group discussion and gentle yoga for veterans, active service duty, and military families who've been affected by brain injury. Hosted by the nonprofit LoveYourBrain. Register in advance; space is limited.
Monday, July 21, 12-2 pm EDT: A webinar, Minds Matter Concussion Model: Acute Clinical Concussion Management, "is open to anyone responsible for implementing a concussion protocol following injury," and all participants will receive an evaluation and treatment toolkit. Presenters include Christina L. Master, MD, who is considered one of the top clinician–researchers in this field. General admission (no continuing education credits) is $30. CEUs are available for ATs, Nurses, PTs, and Physicians; tickets range from $45 to $75.
2024 Annual Impact Report
Check out our 2024 Annual Impact Report!
We're pleased to present our Annual Impact Report for 2024. I'm very proud of this document and the work it represents. Thanks to members of our community like you, Concussion Alliance has been able to educate and support patients and their families, provide education to assist healthcare providers in updating their clinical practices to reflect the new guidelines, and offer unique professional development for passionate undergraduates.
Last year was a significant step forward for the organization, and I hope you enjoy reading about it in the Impact Report. Your support has helped make all of this possible.
Pathophysiology
Real-time monitoring of the glymphatic system may lead to treatments for neurodegenerative disease, including TBI
Researchers at UW Medicine, in collaboration with Applied Cognition, have developed a wearable device that lets scientists observe the glymphatic system, the brain’s waste-clearing system, in human subjects while they sleep. The glymphatic system plays a vital role in clearing the buildup of abnormal brain proteins like phosphorylated tau and beta-amyloid plaque that are a part of neurodegenerative conditions (which can include traumatic brain injury). Their study, published in Nature Biomedical Engineering, indicates that the glymphatic system gradually ramps up its activity during deep and REM sleep, then slowly winds down as people wake up––as opposed to the glymphatic system simply being “on” during sleep and “off” when awake. Critically, this research provides evidence that glymphatic clearance is negatively affected by sleep disturbances.
While this technology is still in development, it offers new insights into brain health and disease risk, especially for conditions like Alzheimer’s, Parkinson’s, and traumatic brain injury. The device offers promise for new early-detection tools and therapies designed to enhance the brain’s natural cleaning system. With further refinement, it could become a standard tool for early detection and personalized treatment strategies focused on enhancing the brain’s natural cleaning system.
Until now, scientists have been able to study the glymphatic system in humans only using MRI, which provides brief snapshots and lacks continuous tracking of the glymphatic system during sleep. But the current study, which included data from an initial study with 35 participants in Florida and a replication study with 14 patients in Washington, found that this wireless head cap could record brain fluid shifts, neural activity signaling sleep stage changes, and changes in the blood vessels of the brain. The head cap collects electrical impedance spectroscopy (EIS) data, EEG, photoplethysmogram (PPG), and impedance plethysmogram readings to measure parenchymal resistance (Rₚ), a proxy for glymphatic activity. In the study, subjects wore the head cap over two separate nights—one with natural sleep and another with periods of being kept awake.
Parenchymal resistance (Rₚ) refers to the resistance of tissues to fluid movement, where lower resistance demonstrates increased fluid movement and or glymphatic clearance. The researchers discovered that lower Rₚ values were associated with signatures of deeper NREM (non-rapid eye movement) and REM sleep stages. The glymphatic system appears to be more active in deeper sleep stages and is affected by sleep disruptions. Further, the study authors state their findings demonstrate that this new wearable device is suitable for defining “sleep-active glymphatic biology in naturalistic settings.”
Diagnostics
EyeBOX is now cleared for acute concussion diagnosis and monitoring concussion recovery over time
Having first achieved FDA approval in 2019, Oculogica’s EyeBOX remains the “only FDA-cleared and Health Canada registered diagnostic aid for concussion that does not require a pre-injury baseline test.” The EyeBOX provides a video for the patient to watch, and the device tracks eye movements, collecting data based on cranial nerve function. Oculogica has recently reported several exciting new developments for the EyeBOX: a new FDA label, a published study by Christina L. Master et al. at Children’s Hospital of Philadelphia, and the inclusion of the EyeBOX in the TRANSCENDENT Concussion Research program in Canada.
The FDA originally cleared the EyeBOX as an aid in diagnosing acute concussions. However, the new FDA label allows providers to use the EyeBOX to monitor a patient’s recovery over time by comparing the patient’s recovery to normative data. Oculagica suggests that this new use will allow providers to “Make clearer, more confident return-to activity decisions supported by normative comparisons,” and “Have greater support for your treatment recommendations.” (Note: Concussion Alliance has no financial relationship with Oculogica.)
A study by Christina L. Master et al. compared the EyeBox with the results of visio–vestibular examination (VVE) and tandem gait assessment. The authors of the study, published in the Journal of Sport and Health Science, found that the EyeBOX can aid in the identification of concussion-related vision disorders in adolescents with persisting post-concussive symptoms. An Oculogica Publications Key-Takeaways summary of the study points out that while early “detection of concussion-related vision dysfunction,” improves outcomes, a specialist with assessment skills may not be available, making the EyeBOX a good option.
The TRANSCENDENT Concussion Research Program in Canada announced that they will be using the EyeBOX in their research studies. Lead researcher Dr. Roger Zemek explains.“‘We are proud to have the unique opportunity to use the EyeBOX as part of our comprehensive TRANSCENDENT Concussion Research Program. This tool provides a rapid, objective assessment of subtle eye movements, and we are excited to explore its potential to enhance clinicians’ ability to identify and differentiate concussions.”
Statistics
CDC national surveys find that the prevalence of concussions/TBIs is dramatically higher than previously estimated
A recent survey summary by Dr. Jill Daugherty et al. found that the prevalence of traumatic brain injuries (TBI), including concussions, is dramatically higher than previously estimated. To fully grasp the frequency of TBIs, the Centers for Disease Control and Prevention (CDC) added questions about TBIs and concussions to several of their national surveys. The results from these surveys, published in The Journal of Head Trauma Rehabilitation, reinforced the CDC's hypothesis that the estimation of TBI prevalence based on healthcare administrative datasets underestimated the actual burden of TBI. Their findings show concussion/TBI incidence each year is 17 to 30 times higher than previously reported, according to a Science Adviser article.
The surveys, administered to both adults and youth (children and adolescents), inquired about head injuries that had occurred within the past 12 months and throughout a person's lifetime. For youth, the prevalence of concussion/TBI in the past 12 months was 17 times higher than previously reported, with 1 in 10 youth sustaining a concussion/TBi in a 12-month period. The 12-month prevalence of sports- and recreation-related concussions in youth ranged from 7-15%, and 10% for concussions that were not specific to sports and recreation. Youth lifetime prevalence of TBI ranged from 6-14%. For adults, the prevalence of concussion/TBI in the past 12 months was 30 times higher than previously reported, with 1 in 8 adults sustaining a concussion/TBi in a 12-month period. Adults reported concussion/TBI with a range of 2-12% within the past 12 months and overall lifetime history with a range of 19-29%.
The previous method of estimating concussion/ TBI prevalence was based on healthcare administrative datasets, which are gleaned from "death certificates and records of hospital and emergency room visits." Those data sets did not account for individuals who did not seek professional care at all or who visited primary or urgent care instead of the hospital. In 2020, it was estimated that fewer than 0.1% of Americans were hospitalized for TBI, which is a significant underestimation compared to the number of self-reported concussions/TBIs on the surveys. These survey results demonstrate that concussion/TBI is a common health condition in the United States. While this data is telling, it is worth noting that the wording differences between surveys impacted the prevalence, and this review included only nationally representative surveys distributed by the CDC. Future research should focus on the specific content and wording of questions and definitions to standardize self-reporting surveys and measures.
This survey summary was a pilot study for the National Concussion Surveillance System, which was to be "a new data system to improve how the U.S. tracks concussions, according to NPR," as discussed in our May 1 article. The elimination of the CDC's entire TBI team means that the work of a National Concussion Surveillance System may not take place and that this survey summary, meant to be a pilot study, may not be followed up on.
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