Ongoing Research Projects

Behavior Modification Concussion Prevention

Principal Investigators: Kevin M. Guskiewicz, PhD, ATC; Jason P. Mihalik, PhD, CAT(C), ATC; and Stephen W. Marshall, PhD
Funding Source: Centers for Disease Control and Prevention National Center for Injury Prevention and Control

Description
This study will be a 3-year long prospective, longitudinal, multi-site investigation designed to reduce the risk of concussion in high school football players. To address this aim, we will incorporate advanced telemetry instrumentation to monitor head impact profiles and identify athletes who may benefit from an individualized coaching and mentoring program designed to address key technical deficiencies related to football play.

   
Football Players

Principal Investigators: Kevin M. Guskiewicz, PhD, ATC and Jason P. Mihalik, PhD, CAT(C), ATC
Funding Source: University of Michigan (Indiana University, Department of Defense, & National Collegiate Athletic Association)

Description
This study will conduct 3-year long prospective, longitudinal, multi-site, multi-sport investigation that delineates the natural history of concussion in males and females, by incorporating a multi-dimensional assessment of standardized clinical measures of pre-concussive and post-concussive symptomatology, performance-based testing (e.g., cognitive function, postural stability) and psychological health.

Football Players

Principal Investigators: Kevin M. Guskiewicz, PhD, ATC and Jason P. Mihalik, PhD, CAT(C)
Funding Sources: Department of Defense & National Collegiate Athletic Association

Description
This study will conduct 3-year long prospective, longitudinal, multi-site, multi-sport investigation that delineates the natural history of concussion in males and females, by incorporating a multi-dimensional assessment of standardized clinical measures of pre-concussive and post-concussive symptomatology, performance-based testing (e.g., cognitive function, postural stability) and psychological health. Football, Lacrosse (men/women) and Soccer (men/women) teams will also engage in an Advanced Research Core (ARC), which utilizes blood biomarkers, genotyping, head impact biomechanics, and imaging to help identify objective markers of concussion.

Clinical Research

Principal Investigator: Kevin M. Guskiewicz, PhD, ATC
Co-Investigators: Weili Lin, PhD, Mario F. Ciocca, MD, Stephen W. Marshall, PhD, Jason P. Mihalik, PhD, CAT(C)
Funding Source: NOCSAE

Description
This project examines the relationship between head impact biomechanics, clinical, and behavioral measures of concussion in high school soccer athletes. An instrumented patch will be provided to male and female soccer players in order to measure head impact data. Pre- and post-season cognitive, balance, and behavioral baseline testing will be performed. Players will repeat the baseline testing following a concussion.

Football

Principal Investigator: Jason P. Mihalik, PhD, CAT(C)
Co-Principal Investigators: Stephen W. Marshall, PhD, Zack Kerr, PhD, Melissa A. Fraser, MS, ATC, J.D. DeFreese, PhD.
Funding Source: United States Army Special Operations Command—Defense Advanced Research Projects Agency

Description
These aims are designed, in general terms, to support our prospective clinical research program, and answer important questions related to neurological health in warrior-athletes. A comprehensive test battery including neurocognition, balance, vision and sensory performance, blood-based biomarkers, and neuroimaging are completed by Special Forces operators. Following brain injury, these measures are repeated and studied in the context of blast exposures sustained by these operators.

Clinical Research

Principal Investigator: Michael Clark, BS
Funding Source: The National Institute of Neurological Disorders and Stroke and The North Carolina Translational and Clinical Sciences Institute (NC TraCS)

Description
The purpose of this research study is to determine if former football players possess characteristics which might increase their risk of cognitive decline (e.g. dementia, Alzheimer’s disease, etc.). Football players have a high prevalence of exposure to prior concussions and sub-concussive impacts. We want to compare retired football players to people who don’t have a history of head impacts or concussions in order to investigate the association between recurrent concussion and cognitive decline. This study will evaluate 50 former football players, a population with a high prevalence of exposure to prior concussion and sub-concussive impacts, and 25 matched control subjects.

   
Hockey Player

Principal Investigator: Kevin M. Guskiewicz, PhD, ATC
Co Investigators: Stephen W. Marshall, PhD, Jason P. Mihalik, PhD, CAT(C), Ashley Littleton, MA, ATC, Melissa A. Fraser, MS, ATC, Robert C. Lynall, MS, ATC, Michael Clark, Elizabeth F. Teel, MS, Kody R. Campbell, MS, Corey Rodrigo, ATC.
Funding Source: National Operating Committee on Standards for Athletic Equipment (NOCSAE)

Description
This study examines the relationship between head impact biomechanics, clinical, and behavioral measures of concussion in high school athletes. The football players will wear helmets with instrumentation, or patches behind the ear, used to measure head impact data. Pre- and post-season cognitive, balance, and behavioral baseline testing will be performed on all participants. All participants will repeat the baseline testing.

Brain Illustration

Principal Investigator: Jason P. Mihalik, PhD, CAT(C), ATC
Funding Source: National Operating Committee on Standards for Athletic Equipment (NOCSAE)

Description
The purpose of this study to get a better understanding of the head impact biomechanics associated with collegiate men’s and women’s soccer and lacrosse by using the X2 Patch and how these measures may correlate with clinical balance and neuropsychological measures. The goal of this study is to accurately quantify the frequency, severity, and location of head impacts that athletes sustain over several years.

Football Players

Principal Investigator: Johna K. Register-Mihalik, PhD, ATC

Co Investigators: Laura Linnan, ScD; Darin Padua, PhD, ATC; Kevin M. Guskiewicz, PhD, ATC; Paul Mihas
Funding Source: UNC Junior Faculty Development Award

Description
The primary goal of this project is to better understand youth coach perceptions concerning the culture of sport and its relationship to injury prevention and safety, using focus groups.

Rugby Players

Principal Investigator: Johna Register-Mihalik, PhD, LAT, ATC
Co-Investigators/Project Team: Valerie De Maio, MD MSc (Co-PI); Josh Bloom, MD, MPH; Janna Fonseca, MEd, ATC; Mackenzie Herzog, MPH; Stephen W. Marshall, PhD; Kevin M. Guskiewicz, PhD, ATC
Funding Source: National Operating Committee on Standards for Athletic Equipment (NOCSAE)

Description
The primary goal of this project is to understand initial presentation factors that may service as prognostic indicators for persistent symptoms and quality of life issues, following sport-related head trauma in children initially presenting to a community based family practice clinic setting.

Football Player

Principal Investigator: Johna K. Register-Mihalik, PhD, ATC
Co-Investigators: Tamara C. Valovich McLeod, PhD, ATC; Kevin M. Guskiewicz, PhD, ATC; Laura A. Linnan, ScD; Jason P. Mihalik, PhD, CAT(C), ATC; Richelle M. Williams, MS, ATC; Stephen W. Marshall, PhD
Funding Source: National Operating Committee on Standards for Athletic Equipment (NOCSAE)

Description
The goals of the study were to:
1) evaluate the effectiveness of a video based educational intervention focused on concussion with and without in-person reinforcement among youth athletes, coaches and parents and
2) understand the baseline levels of knowledge, attitudes, and behaviors concerning concussion in youth sports.

Medical Testing

Principal Investigator: Robert C. Lynall, MS, ATC
Faculty Advisors: Jason P. Mihalik, PhD, CAT(C), ATC; Kevin M. Guskiewicz, PhD, ATC

Funding Source: University of North Carolina at Chapel Hill

Description
This project aims to understand how concussion affects movement; both immediately after the injury and after the athlete has returned to full sport participation. We will measure outcomes related to tandem gait within 48 hours of injury as well as at clinically meaningful time points after the injury and beyond return-to-participation. This will allow us to identify acute deficits as well as establish their recovery timeline. Additionally, we will assess more functional, sport-related movements in athletes who have been concussed and have since returned to activity. These movements will include cutting, jumping, and reacting to external stimulus.

Stretching

Principal Investigator: Robert C. Lynall, MS, ATC
Co-Investigators: Timothy C. Mauntel, MA, ATC; Darin A. Padua, PhD, ATC; Jason P. Mihalik, PhD, CAT(C), ATC;

Funding Source: University of North Carolina at Chapel Hill

Description
This project explored the affect of concussion on lower extremity injury rates. Our findings revealed previously concussed athletes are at an almost 2 times increased risk of lower extremity injury for up to 1 year following concussion.

Students Classroom

Principal Investigator: Ashley Littleton, MA, ATC
Co-Investigators: Kevin M. Guskiewicz, PhD, ATC; Jason P. Mihalik, PhD, CAT(C), ATC; Johna K. Register-Mihalik, PhD, ATC, LAT; Stephen W. Marshall, PhD; Gerard A. Gioia, PhD

Description
We are conducting a study examining how physical and cognitive activity levels post-concussion affect recovery. The study uses a gradual return to school program that will hopefully promote recovery following concussion. If the intervention is effective in promoting recovery, then clear guidelines for returning to academics following concussion can be made. Additionally, with improved evidence and a clarified paradigm, schools may be more receptive to providing accommodations for students following concussion. Overall, this may promote speedier recoveries following concussion, while potentially alleviating the stress of returning to the classroom.

Soccer Girls

Principal Investigator: Melissa A. Fraser, MS, ATC
Co-Investigators: Stephen W. Marshall, PhD; Jason P. Mihalik, PhD, CAT(C); Ashley Littleton, MA, ATC; Melissa A. Fraser, MS, ATC; Robert C. Lynall, MS, ATC; Michael Clark; Elizabeth F. Teel, MS; Kody R. Campbell, MS; Corey Rodrigo, ATC

Description
This project examines the relationship between head impact biomechanics, clinical, and behavioral measures of concussion in high school soccer athletes. An instrumented patch will be provided to male and female soccer players in order to measure head impact data. Pre- and post-season cognitive, balance, and behavioral baseline testing will be performed. Players will repeat the baseline testing following a concussion.

Lacrosse

Principal Investigator: Elizabeth F. Teel, MS
Description
The primary goal of this investigation, is to develop multi-faceted, early implementation rehabilitation programs. In these programs, I hope to create individualized rehabilitation strategies that target multiple domains simultaneously and are started earlier in the recovery process. These programs can include vestibular, visual, and cognitive rehabilitation, along with guided exercise and academic accommodations. The goal of these programs will be promote full recovery from prolonged recovery faster, which will minimize that amount of time an individual is forced to deal with the negative consequences of concussive injuries.

Soccer Girls

Principal Investigator: Kody R. Campbell, MS
Description
This project will explore how measures of neck musculature size, strength and stiffness relate to head impact biomechanics in women’s soccer players. The goal of the study is to understand which of these measures related to the neck musculature can decrease the magnitudes of head accelerations experienced by these athletes. By identifying elements of the neck that reduce the severity of head impacts, these elements could be used to develop a neck-training regime, and hopefully reduce the probability of sustaining a concussive injury during competition.

Women's Lacrosse Ball Scoop

Principal Investigator: Lindsay Smith
Co-Investigators: Melissa A. Fraser, MS, ATC; J.D. DeFreese, PhD; Jason P. Mihalik, PhD, CAT(C); Kristen Kucera, PhD

Description
There is a current need to examine collegiate athletes' psychological health and interventions that may be used to improve it. The primary purpose of this study will be to examine the relationship between athlete optimism and psychological health (including burnout, physical well-being, positive affect, and negative affect). Our secondary purpose of this study will be to identify what changes occur in the psychological health of collegiate athletes after a nine-week motivational imagery intervention. The final purpose will be to explore whether or not collegiate athlete optimism can be manipulated with a motivational imagery intervention.

Mihalik to Keynote CATA Conference

Dr. Jason Mihalik

Congratulations to Dr. Jason Mihalik on his invitation to provide the Keynote Address at the 50th CATA Annual Conference in Vancouver, British Columbia, Canada. The CATA celebrates its 50th anniversary, and Dr. Mihalik is proud to represent UNC in his native Canada for this year's meeting.

Neurotrauma Symposium

Symposium

The 3rd Matthew Gfeller Sport-Related Neurotrauma Symposium was held March 6-7, 2015, on the campus of the University of North Carolina at Chapel Hill. The event took place in the Loudermilk Center for Excellence in the BlueZone, and welcomed some of the great minds in concussion research to share current research and future directions.