A new research study is underway at the Bard Diagnostic Imaging Center in NYC. Dr. Robert Bard and a local research team combines the latest biometric scanning advantages of transcranial DOPPLER imaging, hemodynamic ULTRASOUND scanning (of the retinal, basilary and temporal arteries) and the integration of BIOFEEDBACK technology for a special research study. This neuro-scan review establishes (1) a cross-comparative study between the technologies and (2) a multi-modality screening & monitoring protocol to record post-concussion and neurodegenerative disorders.
One of several major foci for this project is to explore the development of a diagnostic paradigm in the detection of post concussion symptoms including the growing reports of Chronic Traumatic Encephalopathy/CTE, identified from head concussions in military service and high impact sports. Since 2018, Dr. Bard has been collaborating with neurologists and pain management specialists to assess the rampant growth of this progressive brain condition.
The intestinal system is now recognized as a major factor in the immune system. New ultrasound imaging advances allow imaging of the gut wall layers, internal vasculature and areas of inflammation and post inflammatory fibrosis with stricture or deformation. High resolution probes visualize the various segments of digestive organs for scar formation and strain elastography or more recently shear wave elastography quantifies the degree of fibrosis. This exam may be performed endoscopically or by transabdominal probes depending on the location of the organ and type of pathologic process. Certain areas, such as the appendix, are quickly evaluated for appendicitis with high accuracy on CT studies.
Other organs like the pancreas are examined with endoscopic MRI for silent cancers and regional adenopathy. Inflammatory markers of active disease are studied with Doppler flow hemodynamics including 3D measurements of the inflammatory arteries attacking the swollen bowel wall. Disease such as Crohn’s disease, irritable bowel syndrome (IBS) and diverticulitis are accompanied by an influx of feeding vessels. Greater arterial flow in the affected area signifies the likelihood of increased bowel involvement leading to exterior wall adhesions possibly obstructing or strangulating adjacent healthy small bowel loops. Fistulae, abscess and cancers may be observed with real time sonographic evaluation in quick non-invasive surface scanning sessions or with surgical intraoperative imaging for locoregional metastases.
Sunday, June 19, 2022 - One of the most exciting opportunities in neuroscience research today is the use of strategies that protect the brain which may potentially prevent, delay or inhibit the progression of neurodegenerative diseases such as Alzheimer’s, Parkinson’s and ALS. This opportunity rests on our ability for early diagnosis. Research has shown that the likelihood of success for a given treatment-whether lifestyle changes or pharmacological approaches- is highly dependent upon early intervention, before the disease process has become too severe and potentially irreversible. Therefore, it is critical to understand the underlying biological changes that occur in the early stages of these diseases, along with the technology to detect them. (See complete article)
Writing this article reminded me that I, too, am part of this story. I had two episodes of concussion in my teens and early twenties, neither related to sports: one from a fall where I hit my head, another from a car accident that resulted in whiplash. In both of those cases, I was just told to rest until my head stopped hurting and then resume normal activity. Fortunately, I recovered without any long-term issues. In the decades since then, our understanding of head injuries has greatly expanded, prompting innovations in both diagnosis and treatment.
Concussions are viewed as a mild form of traumatic brain injuries and most frequently occur following an event that involves an acceleration–deceleration mechanism without actual injury to the head, such as whiplash, or the head striking an object. As we study these, researchers and clinicians are learning that these are fairly common, but often underdiagnosed.
While the vast majority of people with concussions recover without obvious disability, people can end up with long-term cognitive, emotional and functional issues affecting quality of life – including memory issues and Alzheimer’s disease.  Efforts to better predict outcome from head injuries by focusing on the age, sex, type of injury and acute assessments have led to some improvement, but still fail to predict or explain the variation in healing and outcomes.
Studies in professional athletes have shown that about 80–90% are sufficiently recovered to return to playing within 7–10 days. But that means that 10-20% are not, and their recovery can take up to 3 times longer. Even taking into account variations in initial injury, this variation is difficult to explain or predict. 
DNA is the genetic code that is the blueprint for everything that goes on in our bodies. Genomics is the study of how small changes in our DNA affect how our bodies function. [See feat. on Genomics testing] Research, primarily focused on combat veterans and athletes so far, has shown that these small variations in our DNA may account for at least some of why some people respond to and recover from traumatic brain injury better than others.
The APOE gene plays many roles, including immune response and neuroplasticity. Carriers of the APOE4 gene can be predisposed to worse outcomes after traumatic brain injuries, especially if they are moderate or severe, or there are multiple concussions. While the APOE gene is the most widely studied, there are now over a dozen others that have been identified. Variants in other genes involved in the inflammatory response, blood flow, DNA repair, neuroplasticity, learning and memory are also implicated, including TNF alpha, IL1, IL6, NOS3, ACE, COMT, NMDA receptors, BDNF, KIBRA, MAPT, PARP, MME, SLC17A7, GRIN2A. Because there are hundreds of genes impacting all of these biological systems, it is likely that there are many to be still evaluated, and outcomes are the result of the interaction of multiple genes.
As genomics contributes to our understanding of how and why individuals can vary greatly in their ability to recover from traumatic brain injuries, it is paving the way for more personalized prevention and treatment strategies for concussions. Having accessible and noninvasive technologies to provide evaluation of brain injury and ongoing recovery will be a key part of this progress.
References: (1) https://www.cdc.gov/traumaticbraininjury/concussion/index.html (2) McCrory et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med 2017;0:1–10. (3) Bennett et al. Chapter 9: Genetic Influences in Traumatic Brain Injury, in Laskowitz D, Grant G editors. Translational Research in Traumatic Brain Injury. CRC Press/Taylor and Francis Group 2016. (4) Jane McDevitt & Evgeny Krynetskiy. Genetic findings in sport-related concussions: potential for individualized medicine? Concussion 2017; 2(1).