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Photo Caption:  Gen. John Campbell, then Vice Chief of Staff of the US Army looks on as U.S. Army Maj. Gen. Joseph Caravalho, the Commander of the U.S. Army Medical Research and Materiel Command, and Dr. Mark Emmert, the President of the National Collegiate Athletic Association sign the Cooperative Research and Development Agreement (CRADA) for the NCAA-DOD Grand Alliance. The official CRADA signing took place in May at the Walter Reed National Military Medical Center.

August 27, 2014
By
Stephanie P. Abdullah
Source:  www.army.mil

FORT DETRICK, Md. (Aug. 27, 2014) -- The Army has signed on as the executive agent for the Department of Defense's (DOD) concussion initiative with the National Collegiate Athletic Association (NCAA).

The initiative, known as the Grand Alliance, is a joint venture that will serve to enhance and accelerate research of traumatic injuries and concussive brain injuries, and the development, testing and regulatory approval of screening and diagnostic devices, clinical practice regiments, return to play/return to action protocol, and human prevention strategies, such as resiliency training to prevent such injuries.

Discussions about the Grand Alliance began in March 2013. The talks were prompted by obvious similarities between NCAA student athletes and military personnel - similarities such as youth, athleticism, physical and mental requirements for success as well as vulnerability to traumatic brain injuries (TBI).

"NCAA's student athletes represent the best model system for what happens with concussion in the military," said Col. Dallas Hack, Brain Health and Fitness Research Coordinator for the U.S. Army Medical Research and Materiel Command. "Also, with the NCAA, we have the opportunity to evaluate the athletes not only when they've been injured, but prior to injury and for a significant period of time after the injury," said Hack.

"The alliance has two main lines of effort," he said. "One is a longitudinal natural history study on the course of concussion titled Concussion Assessment, Research and Education (CARE). It will be funded by the alliance and will be the most comprehensive clinical study of the course of concussion ever conducted, thus making it the landmark study on concussion. A subcomponent of the longitudinal study will be the Advanced Research Core (ARC) which will incorporate additional complex assessments at a limited number of sites. The other [line of effort] is education designed for athletes, trainers, coaches and families."

With what they learn through the alliance, the NCAA and DOD hope to establish better concussion prevention, protection, and treatment methods on the field, in garrison and in theater.

"We expect to have a more complete understanding of concussions," said Hack. "We expect to
be able to predict what will happen to people after a concussion. With that information, we can establish protocols that could become the standard that all universities as well as the military can put into place."

Hack said that 37,000 student athletes are anticipated to participate in the study. A variety of sports will be represented including football, soccer, field and ice hockey, tennis, and with support from the service academies, possibly even boxing.

Brian Hainline, who is the Chief Medical Officer for the NCAA and also an NCAA-DOD Grand Alliance Executive Committee member, said the results of the study should be the foundation for much more. "Once we understand better the natural history of concussion, we can systematically study treatment interventions that will not only improve outcome, but also improve neurologic function," said Hainline, who is the NCAA's lead for the alliance.

The educational challenge, the Grand Challenge, is the second main line of effort for the alliance.
It is being designed by NineSigma and will be open to all who want to participate. Participants will submit technology products that focus on developing and accessing concussion education for athletes, trainers, coaches, and parents. The top submitters will be awarded grant funding to see their products through. Although an exact number of potential "winners" is unknown right now, the grant money will be divided among the top participants. Hack will also be on the selection panel the challenge.

Since 2000, more than 300,000 TBIs have been diagnosed within the DOD. More than 175,000 of those are Army specific, with the majority of those taking place in a garrison environment. Most of which are mild traumatic brain injuries (mTBI), also known as concussions.

Concussive events can happen in training, in a combat zone, during sports, driving, or numerous other ways. Because of this, Hack explained, concussion, which is a significant problem for the Army, is here to stay regardless of whether the U.S. is engaged in combat operations. Thus, he said it is critical to have a better understanding of what concussions do to the brain.

The Army is the first of the services to publish mandated TBI guidelines for garrison, represented in the June 2013 Headquarters Department of the Army Guidance for Management of Concussion/Mild Traumatic Brain Injury in the Garrison Setting. The execution order mimics what is already being done in theater and directs any Soldier who is involved in a potentially concussive event to undergo a medical evaluation.

While the Army is the executive agent for the DOD's alliance with the NCAA, all of the services will be involved as each of the service academies has agreed to participate in the study.

Additionally, the working group for TBI, which Hack chairs, is a joint working group with each of the military branches represented in its membership. It was to that working group that Hack made the pitch about this alliance and they recommended that it be funded. According to Hack, the best practices learned as a result of the alliance will be implemented by all of the services.

The Grand Alliance, which is funded for at least the next three years, was announced earlier this year at the White House where it became the focal point of the White House Summit on TBI. The launch event for the Grand Challenge is scheduled for late October in Washington, D.C.

"It's been gratifying to work on this project," said Hack. He plans to stay in the Army a little longer in order to ensure the alliance is up and running before he retires. "With the NCAA's focus, initiative, and move to action, they are making this truly a great alliance," he said.

The Army is also aligned with the National Football League (NFL) in an initiative designed to increase concussion awareness among NFL players and Soldiers and decrease the stigma regarding seeking help for this invisible injury. For more information on TBI, visit www.army.mil/TBI and www.dvbic.dcoe.mil.