MIPS Project Report
Effects of a Chocolate Milk Product
on Mild Traumatic Brain Injury (MTBI) in
Youth Football Athletes
INTRODUCTION
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%.
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.
• 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.
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 FreshTM (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.
PROJECT DESCRIPTION
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 sixcomponent 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
Participants
ImPACT Test
High Schools
Comments
Milk Use Initial N
Boonsboro
Milk
66
Williamsport
Milk
62
South Hagerstown Milk
109 No post tests
North Hagerstown No Milk
70 No post tests
Smithsburg
No Milk
68
Hancock
No Milk
33
Clear Spring
No Milk
66
Total
474
Milk
No Milk
Sway Balance Test
High Schools
198
276
Usable N
W/O Concussion W/ Concussion
80
95
7
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
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
11
RESULTS #1
High School Football Players without Concussion
NomilkMilk p
Composite Scores VerbM
Memory (Visual)
Vis. motor speed
Reaction time
Impulse control
Individual Scores Total symptom Score
Conitive Effeciency Index
Hours slept last night
Hits (immediate)
Correct distractors (immediate)
Learning percent correct
Hits (delay)
Correct distractors (delay)
Delayed memory percent correct
Total percent correct
Hits (immediate)
Correct distractors (immediate)
Learning percent correct
Hits (delay)
Correct distractors (delay)
Delayed memory percent correct
Total percent correct
Total correct (memory)
Total correct (interference)
Average correct RT (interference)
Total incorrect (interference)
Avg. incorrect RT (interfer.)
Total correct (visable)
Avg. correct RT (visable)
Total correct (hidden)
Avg. correct RT (hidden)
Total correct
Avg. correct RT
Total commissions
Avg. commissions RT
Total sequence correct
Total letters correct
Pct. of total letters correct
Avg. time to first click
Avg. counted
Avg. counted correctly
v1
v2
v3
v4
v5
v6
v7
v8
v9
v10
v11
v12
v13
v14
v15
v16
v17
v18
v19
v20
v21
v22
v23
v24
v25
v26
v27
v28
v29
v30
v31
v32
v33
v34
v35
v36
v37
v38
v39
v40
v41
PrePost p
PrePostXNomilkMilk
0.078 No decrease in Milk & Decrease in NoMilk
Increase in Milk & Decrease in NoMilk
No change in Milk & Increase in NoMilk
0.070
0.057
0.043
0.011
0.053
0.084
0.068
0.009 More decrease in Milk (cross)
More decrease in Milk (cross)
0.005
0.040
More decrease in Milk (cross)
0.017 More decrease in Milk (cross)
0.003 More decrease in Milk (cross)
More decrease in Milk (cross)
More decrease in Milk (cross)
0.014
0.013
0.004
0.062
0.003
0.001
More decrease in Milk (cross)
0.009
More increase in Milk (cross)
0.087
0.079
0.098
p
0.087
0.062
All Composite Scores
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
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
ImPACT:
Processing Speed Composite Score
• A higher score indicates better performance on the Processing Speed Composite
• No statistical differences
ImPACT:
Reaction Time Composite Score
• A higher score indicates better performance on the Reaction Time Composite
• No statistical differences
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
Individual Scores
with significant statistical interactions
ImPACT:
Correct distractors (immediate)
ImPACT:
Learning Percent Correct
ImPACT:
Correct Distractors (delay)
ImPACT:
Delayed Memory Percent Correct
ImPACT:
Total Percent Correct
ImPACT:
Hits (Immediate)
ImPACT:
Correct Distractors (Immediate)
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
RESULTS #2
High School Football Players with Concussion
NomilkMilk p
Composite Scores VerbM
Memory (Visual)
Vis. motor speed
Reaction time
Impulse control
Individual Scores Total symptom Score
Conitive Effeciency Index
Hours slept last night
Hits (immediate)
Correct distractors (immediate)
Learning percent correct
Hits (delay)
Correct distractors (delay)
Delayed memory percent correct
Total percent correct
Hits (immediate)
Correct distractors (immediate)
Learning percent correct
Hits (delay)
Correct distractors (delay)
Delayed memory percent correct
Total percent correct
Total correct (memory)
Total correct (interference)
Average correct RT (interference)
Total incorrect (interference)
Avg. incorrect RT (interfer.)
Total correct (visable)
Avg. correct RT (visable)
Total correct (hidden)
Avg. correct RT (hidden)
Total correct
Avg. correct RT
Total commissions
Avg. commissions RT
Total sequence correct
Total letters correct
Pct. of total letters correct
Avg. time to first click
Avg. counted
Avg. counted correctly
v1
v2
v3
v4
v5
v6
v7
v8
v9
v10
v11
v12
v13
v14
v15
v16
v17
v18
v19
v20
v21
v22
v23
v24
v25
v26
v27
v28
v29
v30
v31
v32
v33
v34
v35
v36
v37
v38
v39
v40
v41
PrePost
p
PrePostXNomilkMilk
p
0.099
0.084 No change in Milk & decrease in NoMilk 0.084
0.018
0.08
0.053
Increase in Milk & decrease in NoMilk
0.025
Increase in Milk & decrease in NoMilk
Increase in Milk & decrease in NoMilk
0.018
0.051
All Composite Scores
ImPACT:
Verbal Memory Composite Score
• A higher score indicates better performance on the Verbal Memory Composite
• No significant differences
ImPACT:
Visual Memory Composite Score
• A higher score indicates better performance on the Visual Memory Composite
• No significant differences
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)
ImPACT:
Reaction Time Composite Score
• A higher score indicates better performance on the Reaction Time Composite
• No statistical differences
ImPACT:
Impulse Control Composite Score
• A lower score indicates better performance on the Impulse Control Composite
• No statistical differences
Individual Scores
with significant statistical interactions
ImPACT:
Hits (Immediate)
ImPACT:
Hits (Delay)
ImPACT:
Delayed Memory Percent Correct
ImPACT:
Total Percent Correct
SUMMARY & DISCUSSION
Overall Summary
• High school football players regardless of
concussion during the season showed
positive results overall