Michael Larson, Psychology

Overview

Mild traumatic brain injury, also known as concussion, is a public health concern that is receiving considerable attention in the media and scientific literature. Individuals who experience long-term deficits after concussion show cognitive and emotional dysfunction that can persist or worsen for several years post injury. These deficits can be associated with an increase of fifty percent in medical costs following injury and result in damage to family relationships, employment, and school performance. Currently, there are inadequate numbers of health professionals trained in the accurate diagnosis and identification of predictors of longterm problems following concussion. Furthermore, techniques to identify individuals with persistent symptoms following concussion are sparse and tainted by external motivations. Thus, the purpose of the current mentored learning environment was the training of students in rigorous and cutting-edge research techniques to understand concussion as well as improving our understanding of cost-effective measures that accurately identify individuals who have experienced a concussion. We feel that during the course of this mentored learning experience we accomplished our goals by: 1) immersing undergraduate students in cutting-edge technology and accurate information to understand concussion, and, 2) utilizing physiological measures, including electroencephalogram (EEG) and magnetic resonance imaging (MRI), to determine if these indices are sensitive to the initial effects of concussion. Students were exposed to both EEG and MRI experiences with individuals who experienced a concussion within the first three weeks after the concussion and again approximately nine months after the concussion. Undergraduate students received exposure and training on cutting-edge MRI technology where we examined the volume of the corpus callosum, a white matter structure that connects the two hemispheres of the brain and is susceptible to concussion, and EEG where students applied electrodes that directly measured the time of interhemispheric transfer of information across the corpus callosum in milliseconds.

Academic Objectives and List of Mentored Students

In our opinion, the most important product we anticipated coming from this mentored experience was high-quality undergraduate students with an interest in pursuing a potential career in science or health professions who may one day return to BYU as strong faculty or join the workforce as well-trained and concussion-savvy clinicians. We are confident these experiences will give these students a “leg up” in admissions processes for graduate and professional schools. Below, we outline the students who participated in this experience, their role on the project, and their outcomes in applications for graduate and professional schools.

• Tyshae Davis: Tyshae recently graduated with a Bachelor’s degree in Neuroscience. Tyshae’s role was as study leader. She was responsible for recruiting, scheduling, and assisting individuals with concussion and control participants through the MRI and EEG protocols. Tyshae learned the difficulties of scheduling—particularly as we worked to get participants in for testing rapidly after their concussion. She also learned how to apply EEG electrodes and became Level 1 certified to assist in running participants through the MRI protocol. Tyshae recently applied to medical school and has had several interviews. She indicated that all of her interviews thus far have asked about her research experiences and that she feels her work as the study coordinator for this project have enhanced her medical school application considerably.
• Nathan Alder: Nathan is completing his undergraduate degree in Neuroscience. He will graduate this upcoming April. His experience with the project has been in assisting with the data collection for the EEG and MRI. He is Level 1 certified for the MRI scanner as a result of this project and assisted in a literature review of the project as we prepare for publication. Nathan submitted and was awarded an ORCA grant based on a subset of the findings. He parlayed his research experience into successful applications to medical school. He currently holds offers from four medical schools and has several other interviews scheduled, including one at Harvard Medical School. Similar to Tyshae, Nathan indicated that all of this medical school interviews have asked about his role on the concussion project and that he has benefitted enormously from learning the EEG and MRI cutting-edge technologies taught as part of the mentored environment.
• Kaylie Carbine: Kaylie recently graduated with a Bachelor’s degree in Psychology. Kaylie was the first ever undergraduate student to achieve Level 3 MRI scanner privileges at BYU—meaning she can independently run participants through protocols at the MRI Facility. Level 3 scanner proficiency is typically only reserved for graduate students and faculty; however, Kaylie’s proficiency and exposure based on this mentored learning experience provided her the experience and skills needed to use this incredible technology. Kaylie’s main role on the study was being the scanner operator. She also learned data analysis techniques and was in charge of reducing the MRI data into a useable format. She did this during a graduate MRI Analysis class where she used the data from this study in her analyses and course projects. She has benefitted immensely from this experience and is now a first-year PhD student in BYU’s Psychology PhD program.
• Travis Johnson: Travis is in his last year of the neuroscience program at BYU. Travis assisted in collecting the EEG data associated with this study. Travis’ primary role was to assist with electrode placement, neuropsychological test administration, and ensuring participants were comfortable in the sometimes “cold” research environment. Travis is just about to take the MCAT and he hopes to use his research experience in his upcoming applications to medical schools.
• Two graduate students also benefitted from this mentored learning experience. Ann Clawson and Isaac Hunt are PhD students in the Clinical Psychology PhD program. Isaac was instrumental in running participants through the MRI portion of the study. He was Level 3 certified for the scanner and has subsequently used his Level 3 training for his dissertation gathering MRI data on individuals with obsessive-compulsive disorder. Ann Clawson was instrumental in completing the concussion evaluations to ensure participants actually had experienced a concussion and qualified for the study. As a neuropsychology PhD student, she was qualified to determine if the symptoms were consistent with a concussion and the severity of the concussion. Ann benefitted from learning the concussion clinical interview and she completed most of the clinical evaluations of the concussion participants.

The academic outcomes of this experience in addition to the student learning and experiences are about to be realized. We now have MRI data on 15 individuals with concussion and 15 matched controls. We have an additional 32 individuals with concussion and 19 matched controls with full EEG data. We are continuing to collect the nine-month follow-up sessions on these participants. Once the nine month sessions are complete we will conduct a full data analysis and present the data at the Conference of the International Neuropsychological Society. We also plan to submit the final results to the Journal of the International Neuropsychological Society once the final analyses have taken place. Thus, while we have not yet completed the entire study, we are beyond what we proposed for the MEG grant (15 per group) and think that we will have one of the most complete samples with both EEG and MRI data in the literature to date when we are done. That said, the academic outcomes of posters and papers have not yet been realized, but are hopefully coming soon. We present a preliminary analysis of the outcomes below.

Description of the Results/Findings of the Project

For the EEG portion of the study, we analyzed the Time 1 data as the Time 2 (nine-month) data is still being collected. At the time of analysis, there were 32 individuals who had received a concussion and 19 matched control participants. The mean age of the control group was 22.7 years (SD=2.4), and the mean age of the concussion group was 23.4 years (SD=4.7). We ran a Group by Visual field by Hemisphere repeated measures analysis of variance (ANOVA). The findings indicated a main effect of visual field (F(1,49) = 9.10, p = .004), with faster latencies to the right visual field than the left visual field when collapsed across control and mild TBI groups. Importantly, there was also a Visual field by Hemisphere interaction (F(1,49) = 30.98, p < .001), indicating that the direct pathway across the corpus callosum was faster than the indirect pathway for both visual fields. Unfortunately, the Group by Visual field by Hemisphere interaction was not significant (F(1,49) = .81, p = .37), indicating the speed of interhemispheric transfer was similar between the mild TBI and the control participants. These data were analyzed by Nathan Alder (as noted above) as part of his ORCA and Mentored Environment experiences. For the MRI portion of the study, we compared total gray matter volume, total white matter volume, and volume of the splenium, genu, and body of the corpus callosum between the individuals with concussion and the control participants. Note that, as with the EEG data, these are only the Time 1 data and the Time 2 data are not yet complete. To our surprise, there were no significant differences in values between the concussion and control participants. All t values were < 1.03, p values > .311. These data were analyzed by Kaylie Carbine (as noted above) as part of her Mentored Environment experience.

In summary, preliminary analyses do not show strong evidence for differences between the concussion and control groups on corpus callosum measurements of electrophysiology (EEG) and MRI. We are eager to complete the data collection for Time 2 and to employ more advanced technology like diffusion weighted MRI analyses that may be more sensitive to differences between concussion and control groups. For now, we put these forward as preliminary analyses and hope for increased power and success in our future analyses.

Evaluation of the Mentoring Environment

In evaluating the mentoring environment, I feel we met our primary goals of exposing and training students in unique and cutting-edge mentored experiences in concussion research. As noted above, nearly all the students involved in the project were trained to at least Level 1 on the MRI scanner and some all the way to Level 3 (including the first ever undergraduate at BYU trained to Level 3). Most undergraduate students at any institution are not exposed to MRI research in this way. Furthermore, the addition of EEG computer and sensor experience provides the students with a solid foundation in cognitive neuroscience research that will be useful throughout the future medical or research careers. As you can see, the students who participated in this experience are using the skills they gained for PhD and medical school applications as well as becoming career professionals in neuropsychology. Students received valuable clinical exposure to concussion participants and, given the level of media exposure and attention concussion is receiving right now, have highly visible research experiences on their vitae. Lab meetings and individual student mentoring experiences within this framework were also helpful for teaching MRI, EEG, and clinical skills in relation to concussion. Thus, overall, we feel that the mentoring environment was quite successful and will remain ongoing as we continue to collect data to complete the project.

Description of Expenditures

Given the high cost of MRI and EEG research, we also applied for and received some funding from our college (the College of Family, Home, and Social Sciences) and the MRI Research Facility. Thus, while you will see the funds from the MEG grant have been fully expended, there is still some remaining funds that we are using to complete the second sessions with participants while still paying the students and participants for their help and participation.

• The funds were primarily used to pay for the undergraduate students who worked on the project. Students logged many hours (more than we expected) in recruiting and running participants. The budget ultimately paid for over $9,100 in student wages.
• MRI scans are run at a cost of $200 per hour (our scans for this project took almost exactly one hour). We have completed 30 Session 1 scans (15 per group) and nearly 20 Session 2 scans thus far along with four people who the scanner was scheduled for but did not show or were too late and we were still charged. Thus, 54 scans x $200 = $10,800.
• Funds for the EEG portion of the study were taken from a FHSS College grant in the end.
• Taken together the over $9,100 in student wages + $10,800 in scanning costs = $19,900 of the budget proposed for this project.