NCAA UPDATEBrian Hainline, MD

NCAA Chief Medical OfficerClinical Professor of Neurology

Indiana University School of MedicineNew York University School of Medicine

Sport Science Institute

Mission: To promote and develop safety, excellence, and wellness in college student-

athletes, and to foster life-long physical and mental development.

Sport Science Institute

Vision: To be the pre-eminent sport science voice for all student-athletes and NCAA

member institutions, and to be the steward of best practices for youth and

intercollegiate sports.

Strategic Agenda• Phase I:

– Trust.– Identify Knowledge Gaps.

• Phase II:– Education.– “Eptitude.”

• Phase III:– The NCAA is recognized as the leading Public Health

authority in the sports world.

Knowledge Gaps

Concussion.Mental health.Cardiac health.Overuse & early specialization.Doping & recreational drug use.Data analytics & informatics.Sexual Assault and Interpersonal ViolenceNutrition and Performance

CONCUSSION

Concussion• We do not understand the natural history of

concussion.• We do not understand neurobiological recovery

in concussion.• Solution:

– NCAA-DoD Grand Alliance.• CARE Consortium.• Mind Matters Educational Grand Challenge.

– Inter-Association Guidelines and Legislation.

NCAA and DoD Joint Endeavor

• >97% of military TBIs are concussions.• 85% of military concussions are biomechanically similar to

sport-related concussion.– 15% are from blast injuries.

• College s-a and military service are similar in age, athleticism, risk taking and pushing to the edge of excellence.

• The military theatre is poorly controlled; college sports are a much more controlled environment.

• Numerous meetings, evaluations, culminating in NCAA-DoD MOU and CRADA and White House announcement.

Negotiate 8 Contracts and 22 Sub-Contracts

Submit 24 IRB and HRPO Applications

Convene 2 Investigator Meetings

Develop CSC, ARC, and AOC Protocols

and Conduct Training

Develop SOPs

Launch Website(www.careconsortium.net)

Build CARE Electronic Data Capture System

and Direct Entry Portal

Enrolled 7352 CSC and ARC Athletes/Service Academy Cadets; Collected 176+ Specimens; Injury Data on 245 Concussions

Award Received Sept 2014

TODAY: July 2015

Executive CommitteeHainline (NCAA), Hack & Rauch (DoD), Koroshetz (NIH)

Administrative Coordinating Center:

Indiana U School of MedicineMcAllister (coPI)

Advanced Research Coordinating Center:

Medical College of WisconsinMcCrea (coPI)

Longitudinal Clinical Study Coordinating Center:

U of MichiganBroglio (coPI)

Longitudinal Clinical Study Core (CSC)

Advanced Research Core (ARC)

U Nebraska(BIG10)Molfese

U Michigan(BIG10)Eckner

Washington(PAC12)Chrisman

U North Carolina(ACC)

Guskiewicz & Mihalik

U Pittsburgh(ACC)

Kontos & Collins

U Georgia(SEC)

Schmidt

U Florida(SEC)

Clugston

U Oklahoma(BIG12)

Anderson

UCLA(PAC12)

Giza & DiFiori

Consortium Operating Committee

Anderson, Broglio (co-Chair), Clugston, Duma, Giza, Guskiewicz, McAllister (co-Chair), McCrea (co-Chair), McGinty, Molfese, Putukian

Senior Scientific Advisory Panel

Iverson, Jordan, Kelly, Marshall, Saykin, Smith, Talavage, Wallace, Xu

U Wisconsin(BIG10)Brooks

Princeton(Ivy)

Putukian

Concussion Research Initiative

US Military Academy

(Independent) Svoboda & Kelly

US Air Force Academy

(Mountain West)McGinty & Campbell

US Coast Guard Academy

(New England)Doria

US Naval Academy(Independent)Pyne & Tsao

Virginia Tech(ACC)

Duma & Rowson

U Delaware(Colonial)

Buckley & Kaminski

Humboldt State(California Collegiate)

Ortega

Azusa Pacific(Pacific West)

Hoy

U Rochester(University)

Bazarian

Cal Lutheran(Southern California)

Davis

TBDYear 3

TBDYear 3

TBDYear 3

TBDYear 3

TBDYear 3

TBDYear 3

TBDYear 3

TBDYear 3

TBDYear 3

CSC & ARC Assessment Protocol

Pre-Season Acute Concussion

Sub-Acute Concussion

Post-

Concussion

Baseline<6hrs Post-Injury

24-48hrs Post-Injury

Asymptomatic / Cleared for

Return to Play Progression

Unrestricted Return to

Play7 days

following Return to

Play

6 Months Post-Injury

Neurocognitive and Behavioral Testing (CSC)

X X X X X X X

Blood Biomarker & DNA Collection X X X X X X

Multi-modal MRI Studies O X X X X

Head Impact Measurement: HITS (FB) and non-helmeted sensors (FB, SCR, LAX, IH)

Neurobiological

Pre-Injury Factors

- Genetics- Neurologic

Vulnerabilities

Trauma Burden

- Injury Severity- Repetitive Exposure

- Polytrauma

Biomarkers

- Structural/ Functional

Imaging- Blood

Biomarkers

Psychosocial

Psychological Function

- Premorbid- Post-injury

Comorbidities

Environmental Factors

- Social Support- Life Stressors- Iatrogenesis

Motivational Factors

- Expectation- Secondary

Gain

Multi-Domain Predictor Variables

Neurobiopsychosocial Model

Neurocognitive Function

Neurobehavioral Function

Psychological Health and Wellness

Life Function & Quality

Neurologic Health

Multi-Dimensional Outcome

McCrea, McAllister & Morey, 2012

Advancing the Science of SRC and TBI

Current Status (Sept 11, 2015)

• 13,241 baseline evaluations completed.– 12,004 unique subjects, 1237 in 2nd year.

• 310 concussions captured.• All West Point/Air Force cadets registered.• Developmental stage of youth concussion registry

and rollout of study to youth.• Developmental stage to extend study to 50+ years (to

become the Framingham study of concussion).

NCAA-DoD Mind Matters Educational Grand Challenge

Executive CommitteeLeadership from NCAA (Hainline), DoD (Hack & Rauch), NIH (Koroshetz)

Educational Grand Challenge

Consortium(Operating Committee)

NCAA: Amy Dunham, Latrice Sales, Dana ThomasDoD: Tara Cozzarelli, Stephanie Maxfield-Parker, Kathleen Quinkert

CDC: Kelly SarmientoNine Sigma: Amy Jo Beighley, Denys Resnick, Eloise Young

Immediate Impact Challenge Long-Term Impact Challenge

Inter-Association Guidelines

Independent medical careYear-round practice contactConcussion diagnosis & management

www.ncaa.org/concussionsafety

EndorsementsAmerican Academy of Neurology

American College of Sports MedicineAmerican Association of Neurological

SurgeonsAmerican Medical Society for Sports

MedicineAmerican Orthopaedic Society for

Sports MedicineAmerican Osteopathic Academy for

Sports MedicineCollege Athletic Trainers’ Society

Congress of Neurological SurgeonsNational Athletic Trainers’ Association

NCAA Concussion Task ForceSports Neuropsychological Society

American Football Coaches Association

Football Championship Subdivision Executive Committee

National Association of Collegiate Directors of Athletics

National Football Foundation

MENTAL HEALTH

CARDIAC HEALTH

CARDIAC TASK FORCE

Inter-Association Consensus Recommendations for the Cardiac Care of College Student-Athletes

• Introduction.• Cardiovascular Risk in Student-Athletes.• The Pre-Participation Evaluation.• Evidence Supporting the Use of the Pre-Participation Evaluation for

Detection of Cardiovascular Disease.• The Feasibility and Scientific Validity of Utilizing the Electrocardiogram as

a Screening Tool for the Prevention of Sudden Cardiac Death.• Treatment of Cardiac Arrest.• Cardiac Research Initiatives.• Inter-Association Recommendations.• Checklist.

OVERUSE & EARLY SPECIALIZATION

SOCCER SUMMIT

www.ncaa.org/soccerhealth

WRESTLING SUMMIT

Sport-Specific Summits

• USOC, NGBs, NCAA and invited scientists.• Early Specialization.• Overuse Injuries.• Illnesses.• Periodization.• Concussion Risk.• Rules Implications.• Wellness for Life.

DOPING & RECREATIONAL DRUG USE

Doping and Recreational Drug Use

Doping is cheating.Recreational drug use is different.Inconsistency is problematic.Need: Effective deterrence model.Need: Conference consistency.Need: Effective intervention.

DATA ANALYTICS & INFORMATICS

Injury surveillance

Data Analytics

Evidence-based decisions.No centralized data collection or analysis.Solution: Datalys.Solution: Trust.Target: PPE.

Thank you.