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Volker Musahl, MD, named Division Chief of Sports Medicine

Volker Musahl Volker Musahl, MD has been appointed Division Chief of Sports Medicine in the Department of Orthopaedic Surgery at the University of Pittsburgh School of Medicine. Dr. Musahl is currently Medical Director of UPMC Rooney Sports Complex and also serves as Program Director for the Sports Medicine Fellowship Program. He also serves as Co-Head Team Physician for the varsity football program at the University of Pittsburgh.

Dr. Musahl initially came to the Department in 2000 as an Arbeitsgemeinschaft fur Arthroskopie (AGA) Fellow and completed training as an orthopaedic surgery resident in 2008. Following a Sports Medicine/Shoulder Surgery fellowship at Cornell Medical Center in New York, he returned in 2009 as an Assistant Professor, and was promoted to Associate Professor in 2012. He also holds a joint appointment as Associate Professor in the Department of Bioengineering, Swanson School of Engineering. Dr. Musahl is Board-certified by the American Board of Orthopaedic Surgery with subspecialty certification in Orthopaedic Sports Medicine.

Dr. Musahl’s research interests focus on the clinical and basic science of knee and shoulder injuries in athletes. He and Dr. Richard Debski serve as Co-Director of the Orthopaedic Robotics Laboratory, a state-of-the-art robotics laboratory which is the first of its kind in the United States. Dr. Musahl is currently Co-PI in a multi-center trial on anterior cruciate ligament surgery and research with significant funding from the Department of Defense (DOD). He served as Principal Investigator of an international multicenter trial for the study “Clinical Evaluation and Validation of Pivot Shift following ACL-R” with grant support awarded by the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine. He has been extremely successful in attracting external funding, including more than ten grants from the DOD and NIH, as well as support from foundation, industry, and other sources.

“Dr. Musahl demonstrates a strong commitment to education and continues to accept additional teaching responsibilities related to the education and training of medical students, residents, and fellows as well as athletic training students. He leads the sports medicine lecture series curriculum, mentors the clinical fellows in lectures, journal clubs, wet labs, and in the OR, and also conducts weekly shoulder research group meetings. His commitment to education is further evidenced by his mentoring of bioengineering graduate students. Since 2011, Dr. Musahl has served as Associate Team Physician for the varsity football program at the University of Pittsburgh. He also serves as the team physician for the US Soccer (U-14 boys’ national team) and Mt. Lebanon High School.

Dr. Musahl has gained an international reputation as a leader in the field of sports medicine. He is an outstanding clinician, surgeon, teacher, mentor, and researcher, and we are very fortunate to have such an exemplary member of our faculty, ” said Freddie H. Fu, MD, DSc(Hon.), DPs(Hon.), the David Silver Professor and Chairman in the Department of Orthopaedic Surgery at the University of Pittsburgh School of Medicine.

 

 

 

Concussions are Treatable, More Research Needed, say Leading U.S. Experts in Published Paper

Concussions, often viewed by the public as dire and perplexing, can be effectively treated despite their complexity, according to experts from around the US in a Statement of Agreement available online and published in the December issue of the journal Neurosurgery.

In October, 2015, leading concussion clinicians and researchers gathered at UPMC in Pittsburgh for the “Targeted Evaluation and Active Management” (TEAM) symposium, an unprecedented meeting and white paper designed to propose and share nationally the participants’ agreement on the best practices, protocols and active therapies for treating concussions.

The conference discussions, led by chair Micky Collins, PhD, director of the UPMC Sports Medicine Concussion Program, along with co-directors Anthony Kontos, PhD, and David Okonkwo, MD, PhD, of UPMC and the University of Pittsburgh, resulted in the Statement of Agreement publication. The two-day meeting was fully funded by a grant from the NFL Foundation.

“This conference was remarkable because it brought together a diverse group of leading experts in cutting-edge research and clinical treatment to approach this injury in ways that will help move concussion treatment forward,” said Anthony Kontos, PhD, research director for the UPMC Concussion Program, associate professor in the University of Pittsburgh Department of Orthopaedic Surgery.

The US Center for Disease Control (CDC) estimates that as many as 4 million concussions occur each year in the US, and sport- and recreation-related concussions in particular have increasing incidence. Symptoms, which can be subtle and last days or weeks, include but are not limited to headache, confusion and nausea.

“There has been only limited evidence-based guidance, particularly for primary care providers, about the active treatment of concussion,” Dr. Collins said. “This makes it difficult for clinicians to determine how best to treat patients with this injury. Many are treating patients with concussion using a uniform, rest-based approach today much the same way they did a decade ago.”

Doctors typically advise patients to rest—both the brain and body—until symptoms abate, which might require accommodations at school or work. If the injury was sustained during sports, the patient is instructed not to return to play on the same day and to gradually increase aerobic, exertion-based activity while symptoms are carefully monitored.

But, as described at the symposium and in the published Statement of Agreement, research is beginning to show active rehabilitation can help people recover more quickly and safely than simply resting.

“More research in large, multicenter trials is needed to figure out what kinds of treatments are most effective for a set of symptoms and for individual patients,” Dr. Collins said. Most importantly, we believe concussions are treatable and patients can and do get better.”

A 2015 Harris Poll of more than 2,000 US adults found that 71 percent did not recognize that concussions are treatable. In the same report, 1 in 3 patients who had been diagnosed with a concussion reported receiving no prescribed treatment.

“The purpose of the UPMC symposium was to engage leading clinicians and scientists in a discussion of what we know about concussion and its treatment,” Dr. Okonkwo said. “We hope to build on this effort to share the best available information to improve public understanding and guide future research.”

The authors feel the Statement of Agreement is a step forward in the field and will lead to a collaborative era.

“Over the past decade, many of us individually have accumulated quite a bit of experience about which treatments work for specific symptoms and deficits caused by concussion. We are looking forward to working together to rigorously test these treatments,” said David Brody, MD, PhD, co-author and professor of neurology, Washington University School of Medicine in St Louis.

The Neurosurgery paper was co-written by 37 experts representing 32 clinical and academic institutions, including:

• Jon Almquist, ATC, VATL, ITAT, Fairfax Concussion Center
• Julian Bailes, MD, University Health System, University of Chicago Pritzker School of Medicine
• Mark Barisa, PhD, Baylor Institute for Rehabilitation
• Jeffrey Bazarian, MD, MPH, University of Rochester
• Joshua Bloom, MD, Carolina Sports Concussion Clinic
• David Brody, MD, PhD, Washington University St. Louis
• Robert Cantu, MD, Emerson Hospital, Boston University
• Javier Cardenas, MD, Barrow Neurological Institute
• Jay Clugston, MD, University of Florida
• Randy Cohen, DPT, ATC, University of Arizona
• Ruben Echemendia, PhD, Psychological and Neurobehavioral Associates
• R.J. Elbin, PhD, University of Arkansas Office for Sports Concussion Research
• Richard Ellenbogen, MD, University of Washington
• Janna Fonseca, ATC, Carolina Sports Concussion Clinic
• Gerry Gioia, PhD, Children’s National Health System
• Kevin Guskiewicz, PhD, ATC, University of North Carolina Chapel Hill
• Robert Heyer, MD, Carolinas Medical Center
• Gillian Hotz, PhD, University of Miami
• Grant L. Iverson, PhD, and Ross Zafonte, DO, Harvard Medical School
• Barry Jordan, MD, MPH, Burke Rehabilitation and Research
• Geoffrey Manley, MD, University of California San Francisco
• Joseph Maroon, MD, University of Pittsburgh
• Thomas McAllister, MD, and Daniel Thomas, MD, Indiana University
• Michael McCrea, PhD, Medical College of Wisconsin
• Anne Mucha, DPT, UPMC Centers for Rehabilitation Services
• Beth Pieroth, PhD, North Shore University Health System
• Ken Podell, PhD, Methodist Concussion Center at Houston Hospital
• Matt Pombo, MD, Emory University Healthcare
• Teena Shetty, MD, Hospital for Special Surgery, Weill Cornell Medical College
• Allen Sills, MD, and Gary Soloman, PhD, Vanderbilt University Sports Concussion Center
• Tamara C. Valovich-McLeod, PhD, ATC, FNATA, AT, Still University
• Tony Yates, MD, Pittsburgh Steelers

For more information on concussion research at UPMC, please visit rethinkconcussions.com.

UPMC Will Host Unprecedented Gathering of Concussion Experts to Share Best Treatments, Practices

PITTSBURGH, Aug. 18, 2015 – Nearly 30 leading, independent concussion clinicians and researchers from around the United States will convene at UPMC Oct. 15 and 16 with a unique purpose: to propose standard guidelines on the best practices, protocols and active therapies for treating concussions today, resulting in a white paper to be published in a medical journal and shared nationwide.

For the first time in the relatively infant science of concussion, U.S. experts are coming together to discuss what the UPMC organizers call Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion. Representatives from the National Institutes of Health and the U.S. Department of Defense, among others, also have been invited to participate.

“There’s a gaping need for a consistency of care for concussions across the country, if not the world. To try to fill that void, we’re thrilled to host a meeting of some of the greatest minds in concussion science and clinical care,” said Micky Collins, Ph.D., executive and clinical director of the UPMC Sports Medicine Concussion Program and the chairman of the conference to be held at the U.S. Steel Tower in Pittsburgh, headquarters to UPMC. “It is a privilege to bring together such a group, discuss the issues truly facing concussion health care today, and attempt to share with caregivers everywhere what we find to be the best evidence, science and practices in getting people better.”

The white paper is intended to make scientific, clinical and therapy recommendations for other health care providers to replicate and researchers to study further.

Over the past decade, there have been summits and conferences abroad where participants agreed upon definitions, evaluations and on-field protocols, but this marks the inaugural U.S. meeting focused strictly on active therapies, treatments and best clinical practices for concussions.

“Never before has evidence-based science and clinical experience been brought to bear in advancing concussion treatment like we’re attempting here,” said Anthony Kontos, Ph.D., research director for the UPMC Concussion Program, associate professor in the University of Pittsburgh Department of Orthopaedic Surgery, and co-director of the meeting. “We believe that this meeting will bring together cutting-edge research knowledge and clinical approaches to this injury that will blaze a trail for concussion treatment moving forward.”

The invitees cut across academic, scientific and health care environments. Among those expected to attend are Julian Bailes, M.D., NorthShore University Health System (Chicago) and chairman of the medical advisory board for Pop Warner Football, and retired Gen. Peter Chiarelli, former U.S. Army vice chief of staff and an outspoken leader in research and treatment for traumatic brain injury (TBI), mild TBI such as concussion, and post-traumatic stress.

“There have been numerous advances in our understanding of concussion treatment, and this conference should facilitate the implementation of best practices to make participation in all sports safe,” Dr. Bailes said.

“I am honored to be among this group of leading concussion clinicians and researchers for a meeting that will be a critical step forward in the standard of care for concussions,” Gen. Chiarelli said. “A published consensus statement on concussion treatment will give every patient the opportunity to receive the best care, no matter where they are injured. It’s time to put aside our differences, collaborate and work together for the sake of patients everywhere.”

Added conference co-director David Okonkwo, M.D., Ph.D., professor of neurological surgery and clinical director of the Brain Trauma Research Center at the Pitt School of Medicine: “It is high time to assemble neurosurgeons, neurologists, neuropsychologists, emergency medicine physicians, physiatrists, athletic trainers, physical therapists and all the multidisciplinary health care professionals who are the primary caregivers to people, and not just athletes, troubled by concussions. Let’s effect change and improve outcomes now and for the future.”

UPMC received support to host this meeting because it is aligned with Pittsburgh’s long-standing place at the center of the field: the first sports-medicine concussion program to open its doors (2000), a leading institution in concussion research and innovation, and a model clinic with successful assessment, treatment and outcomes amid its nearly 18,000 concussion-patient visits yearly.

“We are fortunate that we have this opportunity to carry out this idea of spreading better care practices and ultimately helping so many,” Dr. Collins said. “We are looking forward to a wide-ranging, stimulating discussion that is overdue, and we feel our science, innovation and clinical experience make us well suited to serve as hosts.”

The two-day meeting is fully funded by a grant from the NFL Foundation.

“Because of the vital nature of the concussion conversation, it’s critical to support leading institutions in the country, like UPMC, that are promoting science in an effort to advance treatment, evidence and clinical experience,” said Charlotte Jones Anderson, chair of the NFL Foundation and executive vice president of the Dallas Cowboys. “The NFL Foundation is dedicated to improving the health and safety of sports, youth football and the communities in which we live, and we look forward to learning from the experts who will meet in October to further that mission.”

The conference will conclude with a panel discussion and media availability that is expected to be streamed live.

First-of-its-Kind Partnership: UPMC Lemieux Sports Complex Opens

CRANBERRY TWP., Pa., Aug. 17, 2015 – The UPMC Lemieux Sports Complex, a partnership between UPMC and the Pittsburgh Penguins®, officially opened to the public today. The 185,000-square-foot facility is a comprehensive outpatient center for UPMC Sports Medicine and the primary practice and training center for the Penguins, as well as home to their Tier 1 Elite youth programs.

This multi-use facility will be a destination for athletes of all ages and skill levels seeking leading-edge injury prevention and treatment from experts in sports medicine. It focuses on sports medicine and hockey-related research, including injury prevention, training, treatment, and rehabilitation.

“It’s a true partnership between elite hockey and elite sports medicine,” says Vonda Wright, MD, medical director of the UPMC Lemieux Sports Complex. “We have full clinical facilities with experts in orthopaedic surgery, sports performance, primary care sports medicine, physical therapy, athletic training, nutrition, sports psychology, concussion, and musculoskeletal radiology.”

The Lemieux Complex also houses a sports performance center and an expansion of the UPMC Sports Medicine Concussion Program, with both clinical and research space. “We’re expanding on the legacy of elite sports medicine at UPMC,” Dr. Wright says. “We’ll do novel research not only on how to prevent and treat injury, but also how to predict it.”

Five research laboratories come together at the UPMC Lemieux Sports Complex to form the Institute for Sports Performance and Innovative Research (InSPIRe). The core research initiatives of InSPIRe are concussion and traumatic brain injury (TBI), cell therapy and biologics, sports performance, BioDynamics, and material science. Research will aim to answer the prevention, performance, and protection research questions that are important to the futures of young and professional athletes.

The first-of-its-kind facility includes:

  • More than 50 sports medicine experts
  • A sports performance program led by former Pittsburgh Penguins winger, Gary Roberts
  • A practice rink for the Pittsburgh Penguins and a community rink for public use
  • More than 1,500 square feet of hockey skills performance space with a RapidShotTM system, three RapidHandsTM training stations, and a resistance skating lane made of synthetic ice
  • 54,000 square feet of clinical space
  • A physical therapy gym overlooking the Penguins practice rink
  • Aquatic therapy
  • On-site MRI and x-ray imaging
  • Dedicated sports performance space including a sprinting track and batting cages
  • Café and retail space
  • Free parking

For more information about the complex, please visit UPMCLemieuxSportsComplex.com.

USA Hockey Honors UPMC Surgeon Charles “Chip” Burke III with Excellence in Safety Award

PITTSBURGH, June 25, 2015Charles “Chip” Burke III, M.D. of Fox Chapel, was honored with the Excellence in Safety Award at the 2015 USA Hockey’s Annual Congress’ Night of Tribute Awards Dinner. Dr. Burke was recognized for his outstanding contributions in improving safety and reducing injury in youth sports through his 20-year association with USA Hockey.

Dr. Burke, a UPMC orthopaedic surgeon and clinical associate professor at the University of Pittsburgh School of Medicine, has been combining his profession as an orthopaedic surgeon with his passion for the sport of ice hockey at all levels for more than 30 years. His decades of volunteering with USA Hockey have led him to a number of positions, including being a 15-year member of the Safety and Protective Equipment Committee and team physician for the 2002 Winter Olympics. He also has served as part of the Coaching Education Program, teaching coaches about safety in youth sports.

During Dr. Burke’s 25 years as team physician with the Pittsburgh Penguins of the National Hockey League (NHL), he made his most notable contribution to NHL safety by developing the NHL Concussion Program, the largest study of head injuries in sports. The 7-year initiative analyzed head injuries, making large strides in the understanding of concussions. He is past president of the NHL Team Physician’s Society (NHLTPS) and chaired the NHLTPS Injury Committee for many years.

Dr. Burke also was actively involved in establishing the UPMC Sports Medicine Concussion Program in 2000, the first and largest program of its kind, widely considered as the national leader in concussion care and treatment. The center sees patients of all ages and athletic ability, testing for and treating head injuries from a multidisciplinary approach.

“I’ve dedicated my life to making hockey safer so we have fewer injuries,” said Dr. Burke of his decades of work in the game. “Accomplishing this would allow kids to participate more often without injuries that could affect their futures outside of sports. Between USA Hockey and all the work I’ve done with the NHL and UPMC, that’s always been my goal—to give back to the sport.”

USA Hockey relies on volunteers to continue promoting youth sports as a means of providing life lessons hard to find elsewhere. Dr. Burke believes the goal of USA Hockey is not simply to create elite athletes, but to educate and develop the young participants through competition and hard work.

Dr. Burke grew up in Boston playing hockey in a backyard rink with his five brothers. He attended Harvard College, earning a varsity letter in ice hockey. Three of his brothers also lettered in collegiate hockey, two at Harvard and one at Notre Dame.

Dr. Burke practices at Burke and Bradley Orthopedics at UPMC St. Margaret.

UPMC, Pitt Experts Present at AAOS 2015 Annual Meeting

PITTSBURGH, March 30, 2015 – UPMC and the University of Pittsburgh were well-represented at the recent American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting in Las Vegas. UPMC and the Department of Orthopaedic Surgery hosted their annual cocktail reception during the meeting.

Faculty research also was featured in oral and poster presentations throughout the conference, including topics such as:

  • Positive Outcome Bias in the Total Joint Arthroplasty Literature
    Co-authors Carola Van Eck, MD (orthopaedic surgery resident), Adolph Yates Jr, MD
  • Increasing Women and Underrepresented Minorities in Orthopaedic Surgery: A Pipeline Initiative
    Co-author MaCalus Hogan, MD
  • Improving Orthopaedic Resident Surgical Skills Curricula Through Problem-Based Learning
    Co-contributors Adam Rothenberg, MD (orthopaedic surgery resident), MaCalus Hogan, MD, Vincent Deeney, MD, Freddie Fu, MD
  • The Use of Remnant in Individualized Anatomic ACL Reconstruction
    Co-contributor Freddie Fu, MD
  • Does Cross-sectional Area of the Median Nerve Correlate with Severity of Carpal Tunnel Syndrome?
    Co-authors Joseph Imbriglia, MD, William Hagberg, MD, John Fowler, MD
  • Degenerative Spondylolisthesis: An Evidence-Based Assessment of Treatment Options and Outcomes
    Faculty member James Kang, MD
  • Instructional Course: Surgical Management of Cervical Spondylotic Myelopathy
    Moderator James Kang, MD
  • Complications of Surgical Treatment
    Presenter James Kang, MD
  • Pro – Double Bundle Is Best
    Presenter Freddie Fu, MD

As part of the American Orthopaedic Society for Sports Medicine (AOSSM) Specialty Day, Dr. Fu also gave the John C. Kennedy, MD, Lecture entitled, “Anatomic ACL Reconstruction—A Changing Paradigm.”

For more information about the AAOS annual meeting, please visit the conference page.

UPMC Sports Medicine Concussion Program Releases Research Review

PITTSBURGH, Jan. 21, 2015 – The UPMC Sports Medicine Concussion Program has released its 2014 summary of concussion research trends, new research initiatives, publications, and ongoing collaborations from their Research Laboratory.

The UPMC Sports Medicine Concussion Program is under the leadership of director Michael Collins, PhD, associate professor of orthopaedic surgery in the Division of Sports Medicine, and assistant research director Anthony Kontos, PhD, associate professor of orthopaedic surgery in the Division of Sports Medicine.

Research initiatives of the Concussion Program continue to center on advances in empirically based assessment, neuroimaging, targeted treatments, and the effects of concussion in youth sport populations. Much of this research continues to focus on advancing the current clinical standard of care for assessing and treating this injury.

Key research and collaborations featured in the report include,

  • “Targeted Evaluation, Action, and Monitoring for TBI (TEAM-TBI),” a $4.4 million project funded by the United States Department of Defense that focuses on providing veterans and active duty military personnel with a comprehensive assessment and targeted clinical interventions for mild traumatic brain injuries (mTBI).
  • The NFL-GE Head Health Initiative grant to identify concussion and track recovery in athletes using high definition fiber tracking (HDFT) and other clinical measures.
  • Select published papers from UPMC and University of Pittsburgh faculty that were featured in peer-reviewed journals such as the American Journal of Sports Medicine, Pediatrics, and Brain Imaging and Behavior.
  • An ongoing, first-of-its-kind initiative funded by the National Collegiate Athletic Association (NCAA) and the Department of Defense Grand Alliance, and in partnership with Indiana University, the Medical College of Wisconsin, and the University of Michigan, to collect data on NCAA athletes from all sports and military personnel to gain understanding into the multidimensional predictors and outcomes associated with sports-related concussion.
  • President Barack Obama’s selection of Dr. Collins and Dr. Kontos to be among the few chosen clinical and research experts on concussion invited to attend the Healthy Kids and Safe Sports Concussion Summit at the White House where $86 million in funding from various stakeholders was announced.

For more information, please read the full Research Review.

University of Pittsburgh Medical Center Launches Initiative to Emphasize Concussions Are Treatable

PITTSBURGH, Oct. 22, 2014 – At a time when the national concussion conversation instills fear and uncertainty among parents and athletes at all levels, the UPMC Sports Medicine Concussion Program is working to change the current discussion where two powerful messages are lost: Concussions can be treated, and there are evidence-based therapies that result in full recoveries every day.

In striving to shift the national discussion to one based in fact and research, UPMC and the Concussion Program are unveiling the online destination ReThinkConcussions.com as part of an initiative to raise awareness about scientifically proven treatments currently available. The Concussion Program, the first in the world when it opened its doors in 2000, treats more sports-related concussions than any other program nationally with 17,000 patient visits per year. UPMC’s program consistently contributes to innovations in the field with nearly 20 published, peer-reviewed research studies annually.

“An important reality is this: Concussion is treatable if managed properly,” said Michael “Micky” Collins, Ph.D., clinical and executive director of the UPMC Sports Medicine Concussion Program. “With all the new research we’ve done and the nearly 200 papers we’ve helped to publish in the past decade or so, we now are able to provide proven treatments and evidence-based rehabilitation therapies. That should be the conversation now instead of the near-hysteria.”

“People should think of concussions as a treatable injury in the right hands, not some untreatable condition that causes you to retreat to a dark room. The individualized approach to this injury, the ability to use a multidisciplinary team to return patients to normal lives, has changed the course of the injury here – and our successes could be repeated across the world, too,” added Dr. Collins.

RethinkConcussions.com offers an interactive guide to understanding concussions and how UPMC approaches this complex but unseen injury. The website features information on concussion therapies and prevalent myths. It explains UPMC’s multidisciplinary approach to treating six different types of concussions – each carrying its own symptoms and outcomes. Additionally, the site provides insight into patients’ treatment experiences and emotional journeys through some of their stories.

As part of this important initiative, professional athletes and former UPMC patients such as NASCAR great Dale Earnhardt Jr. and Major League catcher David Ross tell their powerful tales in separate videos that will air on television regionally (Ross) and nationally (Earnhardt Jr.), in addition to being found at the new website. Each participated in the spots without compensation, wanting to help spread awareness and education about concussions and their successful rehabilitations.

“We went through activities with results that made sense,” Earnhardt says in his video. He visited the clinic and consulted with Dr. Collins regularly following multiple crashes in fall 2012, keeping him out of consecutive races for the first time in his career. “The best decision I made was to go to UPMC.”

Ross similarly turned to Dr. Collins following two injuries that removed him from behind the plate in 2013. He credits UPMC and its experts with developing an individualized program that allowed him to return to starting at catcher in time for a dramatic post-season run to a championship. As Ross says, “Without UPMC, I would not be a baseball player anymore. They saved my career.”

Other pro athletes who are or will be featured in the ReThinkConcussions.com initiative include former NFL quarterback Brady Quinn, Major League second baseman Brian Roberts and Tyler Hansbrough of the NBA, among others. Athletes of all ages and levels of play – from recreational to amateur to high school and beyond – also will participate in the effort, demonstrating how concussions strike every sport and walk of life.

Dr. Collins and the UPMC Concussion Program have been at the forefront of the national concussion community for years. He is a co-developer of the ImPACT neurocognitive test, a co-author of the Centers for Disease Control’s “Concussion Tool Kit for Physicians,” a consultant to a variety of professional and collegiate leagues, and a frequent presenter nationally and internationally helping to train thousands of health care professionals in concussion management and evaluation.

Dr. Collins leads a team of more than 30 clinicians and researchers, comprised of neuropsychologists, primary care sports medicine physicians, physiatrists, otoneurologists, physical therapists, neurosurgeons, neuroradiologists and orthopaedic surgeons, all devoted to concussion evaluation, treatment and rehabilitation.

“Concussion isn’t something you can detect on a CT scan or an MRI, or with a standard neurologic examination. To ‘see’ this injury you have to know what questions to ask, and our research has shown us this,” Dr. Collins said. “By asking the right questions and looking at the right systems in the right way with the right tools, we can put together a very coherent approach to understanding the injury and determining active treatment strategies. That’s the important message for people to know now.”

UPMC Residency Programs Rank Nationally

Physician network Doximity, along with U.S. News & World Report, announced the first comprehensive national evaluation of residency programs. In these results, 11 UPMC programs ranked in the top 10.

To determine the rankings, 3,691 residency training programs were evaluated by combining over 50,000 peer nominations from board-certified US physicians. U.S. News & World Report, nationally known for their education and health care rankings, consulted on the methodology.

Here is a listing of UPMC programs in the top 10:

  • Anesthesiology: No. 10
  • Obstetrics and gynecology: No. 3
  • Plastic surgery (integrated): No. 3
  • Otolaryngology: No. 4
  • Emergency medicine: No. 7
  • Physical medicine and rehabilitation: No. 7
  • Psychiatry: No. 7
  • Orthopaedic surgery: No. 8
  • Pediatrics: No. 8
  • Neurological surgery: No. 9
  • Surgery: No. 10

The results are used in a free tool from Doximity called Residency Navigator. The tool is designed for third- and fourth-year medical students.

Pitt, UPMC Researchers Create New Vestibular Test to Add to Comprehensive Concussion Evaluation

PITTSBURGH, Sept. 10, 2014 – Researchers at UPMC and the University of Pittsburgh have created a new, 5- to 10-minute test that could be added to a clinician’s concussion evaluation toolkit for a more comprehensive assessment of the injury. 

In a recent study published online first by the American Journal of Sports Medicine, researchers from the UPMC Sports Medicine Concussion Program demonstrated that clinicians could use their novel Vestibular/Ocular Motor Screening (VOMS) examination to be 90 percent accurate in identifying patients with concussion. The VOMS, which requires such minimal equipment as a tape measure and a metronome, was shown to be a valid and consistent tool to enhance the current multi-disciplinary approaches to concussion assessment that include clinical examination, symptom evaluation and computerized neurocognitive testing. 

Previous research conducted at UPMC identified the vestibular ocular system — responsible for integrating vision, balance and movement — as being the most predictive of longer outcomes from sports-related concussions. However, the researchers reported, most current evaluation and management tools for vestibular issues focus on balance, potentially missing important pieces of the concussion puzzle. In fact, the Sideline Assessment of Concussion (SAC), Sport Concussion Assessment Tool-3 (SCAT-3), Balance Error Scoring System (BESS), and similar tests fail to both comprehensively evaluate the vestibular system and measure ocular-motor dysfunction, they added.

“We were afraid that important findings were being missed in many patients following their concussion because we just didn’t have the right tool to measure this part of the injury,” said Anne Mucha, D.P.T., Concussion Program clinical coordinator for vestibular therapy and principal investigator in this research. “Current assessments clearly weren’t sufficient in identifying most of the dizziness and visual problems that we commonly see in our patients.”

“The VOMS is another tool in our toolkit,” said Michael “Micky” Collins, Ph.D., Concussion Program executive and clinical director who took part in this study. “For the past five to 10 years, our research has revealed that vision issues, fogginess and dizziness are symptoms associated with the worst outcomes in our patients. So we set out to create an evidence-based examination to assess these areas.”

The researchers studied 64 concussed patients approximately five days post-injury and 78 healthy control-group patients who were administered VOMS by trained clinicians. The VOMS, which was developed in conjunction with a multi-disciplinary team of UPMC experts, assesses five areas of the vestibular ocular system: smooth pursuits, saccades (rapid eye movement), horizontal vestibular ocular reflex, visual motion sensitivity, and near-point-of-convergence distance. Standardized screening instructions are attached as appendices with the journal paper.

“The results from the current study indicated that more than 60 percent of patients experienced symptoms following the VOMS — and these are patients whose impairments might have been missed without a tool like it,” said Anthony Kontos, Ph.D., Concussion Program assistant research director and senior investigator.

“Current assessment tools are not looking at these issues, which concerns us greatly,” Dr. Collins said. “We are seeing many young athletes who, in addition to neurocognitive deficiencies, are coming to us with vestibular ocular impairment. The VOMS provides a more specific evaluation that can help us better treat these patients using targeted treatment pathways. By integrating the VOMS with current tools, clinicians could very well foster a paradigm shift in concussion diagnosis and management.”

Other co-authors were: Joseph Furman, M.D., Ph.D., Pitt departments of Otolaryngology, Neurology, Bioengineering and Physical Therapy as well as Director, UPMC Division of Balance Disorders; Greg Marchetti, Ph.D., of Duquesne University; former Pitt researcher R.J. Elbin, Ph.D., University of Arkansas; and Cara Troutman-Enseki, D.P.T., and Ryan DeWolf, M.S., UPMC Concussion Program. The study was supported in part by a grant from the National Institute on Deafness and Other Communication Disorders, No. 1K01DC012332-01A1.

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