1. MIPS Project Report Effects of a Chocolate Milk Product on Mild Traumatic Brain Injury (MTBI) in Youth Football Athletes

2. INTRODUCTION

3. Background MTBI, also known as concussion, is a type of traumatic brain injury caused by a bump, blow, or jolt to the head that causes negative consequences to brain function, specifically, in cognition and movement control by the brain. MTBI can also occur from a blow to the body that causes the head and brain to move back and forth, which is often observed in almost all sports. Sports are associated with incredibly high numbers of MTBI incidents, especially in youth and collegial sports. MTBIs in children and young athletes can cause serious health-related issues, such as memory lapses and brain swelling, which can sometimes lead to fatal consequences. Institute of Medicine estimates that the MTBI risk for males in football is about 75% and the risk for females in soccer is about 50%.

4. Background Because of the importance of BCAAs in energy metabolism and neurotransmitter synthesis in the brain, previous studies investigated the effects of the intravenous supplementation (Aquilani et al. 2005) and dietary supplementation of BCAAs (Cole et al. 2010) on the cognition of patients with brain injuries and observed the improved cognition in the injured patients with the supplementation.Aquilani et al. 2005Cole et al. 2010 Previous studies showed that mice with brain trauma exhibited faster improvement in cognitive function following the oral consumption of BCAAs immediately after the injury. The efficacy of brain healing following concussions in humans is currently under investigation in the scientific community. In these study, BCAAs are being administered orally to subjects to assess their ability to improve healing. However, the efficacy of the dairy products containing BCAAs has not been studied and is not currently under investigation to our knowledge.

5. Chocolate Milk Chocolate milk has been shown to be an effective post-workout recovery drink. Its balance of fast-absorbed and sustained-released proteins provides a quick burst of amino acids followed by a continuous supply over several more hours. Chocolate milk also provides a sustained source of carbohydrates and calcium which are critical for the recovery process after brain injuries. Fifth Quarter Fresh TM (FQF), a natural fat-free chocolate milk recovery drink, was used for this study. – The protein in FQF contains a natural blend of fast absorbed whey protein and sustained release casein protein that are the essential amino acids muscles require for quick muscle repair and muscle fiber building. – FQF is also pasteurized at a normal temperature to preserve all of its amino acids. FQF differs from most protein recovery drinks that use whey products, which are Ultra-High Temperature (UHT) pasteurized and dried at high heat. The high heat damages protein and makes it less absorbable by the body. – FQF also contains higher levels of calcium, magnesium, potassium, and sodium than regular chocolate milk. These electrolytes are critical to helping the body replace lost nutrients and to retain the fluids that are needed for recovery of muscle and brain cells.

6. PROJECT DESCRIPTION

7. Research Site & Facilities The Neuromechanics Laboratory (NML) at the University of Maryland, College Park, conducted the study The NML (6,500 sq ft) is equipped with two Kincom machines; Noraxon 18-channel electromyography system; Kistler, Bertec, and AMTI six- component force plates and load cells; 12-camera Vicon motion capture/analysis system, Visual 3D, and Kwon3D motion analysis systems; electro-goniometers; three treadmills; and a stationary metabolic analysis system. This research space is well equipped with computers and software necessary for data collection and analysis

8. Participants

9. Participants & Experimental Design Subjects – High school football players in Washington Co., MD 7 schools (n=66, n=62, n=70, n=109, n=68, n=33, n=66; Total=474) Experimental Design & Statistics – Repeated-measures design – 2-Way Repeated-Measures ANOVA 1 within-subject factor: Pre-season vs. Post-season 1 between-subject factor: Milk group vs. Non-milk group – Significance level: p<.10 9

10. Tests: High School Football ImPACT Test – Word Discrimination: Evaluates attentional processes and verbal recognition memory utilizing a word discrimination paradigm – Design Memory: Evaluates attentional processes and visual recognition memory using a design discrimination paradigm – X's and O's: Measures visual working memory as well as visual processing speed and consists of a visual memory paradigm with a distractor task that measures response speed – Symbol Matching: Evaluates visual processing speed, learning and memory – Color Match: Represents a choice reaction time task and also measures impulse control and response inhibition – Three Letter Memory: Measures working memory and visual-motor response speed 10

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12. RESULTS #1 High School Football Players without Concussion

14. All Composite Scores

15. ImPACT: Verbal Memory Composite Score A higher score indicates better performance on the Verbal Memory Composite No change in Milk & decrease in No Milk (p=.087): positive result

16. ImPACT: Visual Memory Composite Score A higher score indicates better performance on the Visual Memory Composite Increase in Milk & decrease in No Milk (p=.062): positive result

17. ImPACT: Processing Speed Composite Score A higher score indicates better performance on the Processing Speed Composite No statistical differences

18. ImPACT: Reaction Time Composite Score A higher score indicates better performance on the Reaction Time Composite No statistical differences

19. ImPACT: Impulse Control Composite Score A lower score indicates better performance on the Impulse Control Composite No changes in Milk & increase in No Milk (p=.084): positive result

20. Individual Scores with significant statistical interactions

21. ImPACT: Correct distractors (immediate)

22. ImPACT: Learning Percent Correct

23. ImPACT: Correct Distractors (delay)

24. ImPACT: Delayed Memory Percent Correct

25. ImPACT: Total Percent Correct

26. ImPACT: Hits (Immediate)

27. ImPACT: Correct Distractors (Immediate)

28. Summary High school football players who consumed FQF during the season improved their individual ImPACT scores after the season as compared to the players who did not consume FQF: Positive results overall

29. RESULTS #2 High School Football Players with Concussion

31. All Composite Scores

32. ImPACT: Verbal Memory Composite Score A higher score indicates better performance on the Verbal Memory Composite No significant differences

33. ImPACT: Visual Memory Composite Score A higher score indicates better performance on the Visual Memory Composite No significant differences

34. ImPACT: Processing Speed Composite Score A higher score indicates better performance on the Processing Speed Composite Significant Group effect: Milk < No Milk (p=0.098)

35. ImPACT: Reaction Time Composite Score A higher score indicates better performance on the Reaction Time Composite No statistical differences

36. ImPACT: Impulse Control Composite Score A lower score indicates better performance on the Impulse Control Composite No statistical differences

37. Individual Scores with significant statistical interactions

38. ImPACT: Hits (Immediate)

39. ImPACT: Hits (Delay)

40. ImPACT: Delayed Memory Percent Correct

41. ImPACT: Total Percent Correct

42. SUMMARY & DISCUSSION

43. Overall Summary High school football players regardless of concussion during the season showed positive results overall