Why was the CARE Consortium Created?
Concussion (i.e., mild traumatic brain injury, or mTBI) is recognized by the U.S. military, the sports medicine community and society at large as a major public health concern. While significant attention has focused on blast and other war-related head trauma, a substantial number of military service members continue to sustain concussion through sports participation and other training activities. In fact, from 2000 to 2017, 86% of brain injuries in the military occurred during day-to-day activities unrelated to deployment. Because of the concerns related to mTBI and its potential negative consequences on health, the Department of Defense (DoD), U.S. Military Service Academies (MSAs), and national sporting agencies are being pressured to minimize or even eliminate activities with an increased concussion risk.
To inform decision making around these concerns, the U.S. DoD and the National Collegiate Athletic Association (NCAA) established the NCAA–DoD Grand Alliance and the Concussion Assessment, Research and Education (CARE) Consortium. Through this public-private partnership, CARE is defining the clinical and neurobiological natural history of concussive injury and recovery.
In its first phase, CARE has enrolled over 37,000 MSA cadets and NCAA athletes. In addition, over 2,500 3.300 concussed cadets and athletes have undergone detailed post-injury characterization. As the largest prospective concussion study ever conducted, CARE is addressing key knowledge gaps on the six-month natural history of clinical and neurobiological recovery, the acute and sub-acute effects of concussion on brain structure and function, and factors that predict poor outcomes in MSA members and NCAA student-athletes.
Why CARE 2.0 ?
Despite advances made by CARE and similar studies, a panel of international experts at the 5th International Consensus Conference on Concussion recently concluded from a systematic literature review that “there is much more to learn about the potential cause-and-effect relationships of repet¬itive head-impact exposure and concussions.” 5 Specifically, this report highlighted several gaps in the existing evidence on the extent to which repetitive concussion and head impact exposure result in static or progressive changes in brain structure and function, and in turn, lead to cumulative and persistent cognitive, psychological and neurologic health problems. The expert panel ultimately called for well-designed prospective, case control and cohort studies to investigate the potential cumulative and lasting effects of repetitive concussion and head impact exposure.
Consistent with the identified concerns, the overarching goal of the CARE 2.0 studies are to address pressing public health questions surrounding the intermediate cumulative and persistent effects of concussion and/or repetitive head impact exposure on neurological health in MSA cadets and NCAA student-athletes by leveraging the infrastructure and scientific achievements of the CARE Consortium. While the initial phase of CARE focused on the six-month natural history and neurobiology of acute and sub-acute concussion, CARE 2.0 will employ an innovative, prospective research design to determine if there are intermediate cumulative effects (i.e., alterations over a MSA/collegiate career) and persistent effects (i.e., ongoing signs/symptoms up to 4-years following MSA/collegiate graduation) associated with concussion and/or head impact exposure.
Thomas W. McAllister, M.D., is the Albert Eugene Sterne Professor and Chairman, Indiana University School of Medicine Department of Psychiatry. He was previously Millennium Professor of Psychiatry and Neurology, Director of the Section of Neuropsychiatry at Dartmouth Medical School, and Vice Chair for Neuroscience Research for the Department of Psychiatry. He is a past president of the American Neuropsychiatric Association. Dr. McAllister received his undergraduate degree from Dartmouth College, and his medical degree from Dartmouth Medical School. He served on the faculties of the University of Kentucky, and the University of Pennsylvania before returning to Dartmouth Medical School in 1990.
Dr. McAllister has been working in the field of brain injury recovery for over 25 years. He has written widely on the neuropsychiatric sequelae of TBI, and is the principal investigator of several grants from NIH, the CDC, NOCSAE, and the Department of Defense (DoD), exploring the nature of cognitive and behavioral difficulties following mild and moderate TBI. With Drs. Jon Silver and Stuart Yudofsky he is a co-editor of the Textbook of Traumatic Brain Injury published by American Psychiatric Publishing, Inc. Recent research has focused on characterizing the biomechanical basis of concussion, and the effects of repetitive head impacts on brain structure and function in contact sport athletes.
Michael McCrea, PhD, ABPP is Professor of Neurosurgery and Neurology and Director of Brain Injury Research at the Medical College of Wisconsin, and a research neuropsychologist at the Clement Zablocki VA Medical Center in Milwaukee, Wisconsin. He is ABCN board-certified in clinical neuropsychology and is the past President of the American Academy of Clinical Neuropsychology (AACN). Dr. McCrea has been an active researcher in the neurosciences, with numerous scientific publications, book chapters, and national and international lectures on the topic of traumatic brain injury. Dr. McCrea has led several large, multi-center studies on the effects of traumatic brain injury and sport-related concussion. Dr. McCrea has authored numerous peer-reviewed publications and book chapters on the acute and chronic effects of concussion, and he authored the text Mild Traumatic Brain Injury and Postconcussion Syndrome: The New Evidence Base for Diagnosis and Treatment published by Oxford University Press. He currently serves on the National Football League (NFL) Head, Neck and Spine Committee and as a neuropsychology consultant for the Green Bay Packers, and served as a panelist on the 2008 and 2012 Zurich International Consensus Conference on Sports Concussion.
Steven Broglio PhD, ATC is an Associate Professor at the University of Michigan in the School of Kinesiology and Departments of Neurology and Physical Medicine and Rehabilitation. He is also Director of the NeuroSport Research Laboratory and member of the University of Michigan Injury Center. Dr. Broglio is a Certified Athletic Trainer who received his undergraduate degree from the University of North Carolina at Chapel Hill in 2000, his Master’s Degree from the University of Pittsburgh in 2002, and his Doctorate from the University of Georgia in 2006. His first faculty position was in the Department of Kinesiology and Community Health at the University of Illinois at Urban-Champaign from 2006 to 2011.
Dr. Broglio has been conducting sport concussion research since 1999, in which he has continually focused on improving athlete health and safety through injury prevention, early recognition, and management. These efforts have been supported by the National Athletic Trainers’ Research and Education Foundation, the National Institutes of Health, the National Collegiate Athletic Association, and the Department of Defense and are chronicled in medical journals and book chapters. Dr. Broglio was awarded the new investigator award by the National Athletic Trainers’ Association in 2011 and Fellowship in the American College of Sports Medicine in 2014.
Colonel (Ret.) Paul. F. Pasquina, M.D. is the Professor and Chair of the Department of Rehabilitation Medicine and Director of the Center for Rehabilitation Sciences Research (CRSR) at the Uniformed Services University of the Health Sciences (USUHS). He is also the Chief of the Department of Rehabilitation at Walter Reed National Military Medical Center (WRNMMC). He is a graduate of the United States Military Academy at West Point and USUHS, completed his residency at Walter Reed Army Medical Center and completed a fellowship in primary care sports medicine at Georgetown/USUHS. His board certifications include PM&R, Electrodiagnostic Medicine, and Pain Medicine. His current research efforts are focused on exploring new technologies to enhance the recovery, rehabilitation, and reintegration of combat casualties, primarily through his work as the Director of the Center for Rehabilitation Sciences Research (www.CRSR.org).
The CARE Consortium existing organizational structure will be utilized to lead the CARE 2.0 studies.
Administrative and Operations Core (AOC): The AOC serves as the centralized coordination center for the Longitudinal Clinical Study and Advanced Research Cores (CSC) and Advanced Research Core (ARC), and Consortium members. The AOC also provides regu;atory and financial oversight for the Consortium, as well as supports the CARE regulatory and financial oversight for the Consortium, as well as supports the CARE Biostatistics and Data Management Team (BDMT), CARE Biospecimens Team, and CARE Bioinformatics Team.
Longitudinal Clinical Study Core (CSC): The CSC has implemented a multi-year, multi-site, prospective, longitudinal investigation of concussive and repetitive head impacts in NCAA student-athletes to develop and implement a multi-year, multi-site, prospective, clinical longitudinal research protocol whose aim is to study the natural history of concussion. The CSC serves as the foundation upon which additional advanced research projects are built
Advanced Research Core (ARC): The ARC leveraged existing collaborative research networks (e.g., NIH TRACK-TBI, DoD Project Head to Head, NFL-GE Head Health Challenge) to conduct advanced research projects that include, but are not limited to, impact sensor technologies, advanced neuroimaging, biological markers and comprehensive clinical studies to inform the neurobiopsychosocial understanding ofconcussion. The ARC builds upon the CSC, thereby allowing for advanced research projects with the same foundational baseline and post-concussive clinical data.
An important leadership Team is added for CARE 2.0 and it focuses on the Military Services Academies (MSAs). The Uniformed Services University of the Health Sciences (USUHS).
CARE Consortium Standing Committees
Consortium work is supported by several committees, which are comprised of Consortium members, as well as content-specific experts external to the Consortium. The Administrative Operations Core (AOC) will provide support for committee functions. The standing committees are described below:
Executive Committee (EC)
Representatives from the DOD, NCAA and NIH
Oversees the Operating Committee and Consortium activities
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Publication Committee (PC)
Representatives from Consortium investigators with demonstrated expertise in science
Operating Committee (OC)
Representatives from Consortium investigators with demonstrated expertise in science and clinical management of sports-related concussion
Scientific Advisory Board (SAB)
Representatives from the field of SRC research with demonstrated scientific expertise
Provides consultation regarding, and independent review of, the