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The gaming and hospitality industry has been synonymous with Las Vegas for decades.

But a new enterprise has moved in, and is jockeying for the top spot.

From professional fighting, soccer, and hockey, to minor league baseball and the National Football League, Las Vegas has transformed from the entertainment capital of the world to a sports haven practically overnight. 

To Jefferson Kinney, chair of ���ӽ紫ý’s new department of Brain Health, this transformation makes the city the perfect place to discover potential breakthroughs for one of today’s leading public health concerns: traumatic brain injury (TBI).

TBI is a disruption in the normal function of the brain that can be caused by a bump, blow, or jolt to the head. It’s a common injury associated with sports, catching the interest of more and more researchers as the impacts of the disease on athletes continue to make news headlines.

“It happens in car crashes, it happens when people fall, but sports are more primed for it,” Kinney said. “In sports, people are moving fast into hard objects or into each other. And if you hit your head, it’s possible you’re going to cause a TBI.”

Effects of TBI can include impairments related to thinking or memory, movement, sensation, or emotional functioning. A TBI can increase the risk for other injuries and neurodegenerative conditions such as Alzheimer’s and Parkinson’s disease, but there’s still a lot we don’t know, said Kinney. 

That’s why he’s adding to the work already underway at ���ӽ紫ý. He’s collaborating with the Cleveland Clinic Lou Ruvo Center for Brain Health and Indiana University to build an interdisciplinary group of ���ӽ紫ý researchers and community partners to study TBI, with one overarching goal in mind: progress. He believes some of the answers lie in blood-based biomarkers — proteins in the blood that can be measured for absence of, change in, or presence of, disease.

“If someone has high blood pressure, you can diagnose and give them a drug, and then after some time has passed, you measure it again,” Kinney said. “If the biomarkers show that it’s no longer high, you’ve taken care of the difficulty. But when it comes to determining when a football player can return to the game after experiencing a TBI, it’s an estimation. It’s more subjective than treating other conditions.”

As Kinney and his group of researchers build upon the hard work already underway to answer these and other questions, we sat down with him to take a closer look at this complex and sometimes confounding disease.

What do we know about Traumatic Brain Injury? What’s the least understood aspect of TBI?

What we know is that it’s trauma to the brain in some way, shape, or form which causes anything from loss of consciousness and brain injury, to subtle difficulties in cognitive function or motor coordination and the way that the brain works.

The severity of the trauma is thought to be a big predictor of how bad the short- and long-term effects can be; however, one big unknown is whether one massive blow to the head is worse or the same as several smaller, sub-concussive blows.

We also don’t know, conclusively, the number of TBIs in elementary, middle, and high school sports. Massive TBIs that lead to a loss of consciousness usually aren’t missed, but it’s the ones that don’t rise to that level of severity that fly under the radar. Are they being missed? 

When it comes to severe TBIs in sports, most people are concerned with how soon a player can return to play. But there is no really good measure for that. There’s an assessment done at the time of the injury, and then the individual is screened on a regular basis, but the assessment is an estimation. It’s not an absolute.

How is the sports industry mitigating the risks associated with TBI?

They’re doing a lot. The sports industry is supportive of finding a better way to diagnose TBIs. There are also more protocols in place, particularly in youth sports, to help limit the risk of young athletes experiencing TBIs.

In football, if there’s any indication that someone took a concussive blow to the head, the player needs to be immediately assessed. Some high school athletic programs are assessing students at the beginning of the season so that they have a baseline for if and when a concussive event occurs. A few states are exploring age-related restrictions on tackle football.

In soccer, players aren’t allowed to head the ball until after a certain age; in hockey, body checks aren’t allowed until children reach the 13-14 age level, up from the 11-12 age group previously. The sports industry, as a whole, has been trying to cut down on the number of concussive events early on in the hopes that that will alleviate future health concerns.

What are some tips for parents whose children are entering sports? 

Make sure that the organization knows about TBI, that they’re watching for it, that they’re protecting against it. Don’t wait until after something has happened, and you’re left wondering. Make sure it’s on their radar, and ask questions. Coaches need to be informed about it and should be able to answer questions about it.

If your child is playing sports — which is great, sports are phenomenal for overall health and brain health — be mindful of the symptoms associated with TBI. Did they tell you that at practice today they hit their head a bunch of times? Are they groggy? Are they more sleepy than usual teenager behavior? Have you noticed any changes in their speech? 

Are there reliable treatments for TBI available today?

If someone experiences a TBI, doctors guard against symptoms like brain bleeds and additional injuries. But beyond that, there isn’t a treatment regime. There’s not a drug that can be administered reliably that’s going to dissipate concussive symptoms. A lot of research, including ours, is being directed to a point where a reliable treatment could be administered or a reliable marker indicating recovery is available.

Are some people more susceptible to TBI?

We don’t know, and part of our research endeavor will be geared toward answering this question. One part of this team approach will be looking to see if there are genes that confer resistance or susceptibility to TBI. 

What will people see from the work happening at ���ӽ紫ý?

We’re taking an interdisciplinary approach to study TBI both in sports and from other causes. We’re going to build on current research that we’re doing — in collaboration with the Cleveland Clinic Lou Ruvo Center for Brain Health — with mixed martial arts fighters and boxers. We’ve evaluated the athletes for a number of cognitive measures; blood samples from those fighters are being examined for biomarkers associated with TBI. The data we have so far are amazingly interesting and have found a marker that shows a large difference between the athletes and control groups. Our next step is to turn this into a systemic investigation of what’s going on.

We plan to take a multi-sport approach to understanding TBI. We’re going to build off of the biomarker discovery platform that we’ve created and incorporate blood samples from athletes of several sports, even sports that aren’t on anyone else’s radar. We’re collaborating with ���ӽ紫ý researchers in neuropsychology and kinesiology, area physicians, the Lou Ruvo Center for Brain Health, and we’re also exploring collaborations with companies that develop measures for cognitive assessments. Collaborating with researchers in kinesiology, for example, will help us further explore the question of whether or not a traumatic brain injury increases the likelihood of peripheral injuries like knee sprains and muscle tears. If your brain isn’t working the way it should, balance, coordination and overall function gets compromised.

We’re also trying to find the mechanism(s) that associates TBI and neurodegenerative disorders such as Alzheimer’s disease. Biomarkers will be examined over time to see if they recover back to normal, and compare that to Alzheimer’s populations. Some of our athletes that we’re studying will never have a concussive event over the course of a season, but we already know that there’s some markers that change just based on their involvement in the sport.

Overall, we’re hoping our work will result in progress — progress towards understanding if there are viable biomarkers for TBI which can contribute to diagnosis, recovery, and treatment.