TISS Research Accelerator Grants support research projects bridging sport science & sport medicine

Associate Professor Kelly Arbour Nicitopoulos is the principal investigator of one of the seven research projects funded by the TISS Research Accelerator Grants (photo credit: Dewey Chang)
Associate Professor Kelly Arbour Nicitopoulos is the principal investigator of one of the seven research projects funded by the TISS Research Accelerator Grants (photo credit: Dewey Chang)

The Tanenbaum Institute for Science in Sport (TISS) has awarded seven teams of researchers affiliated with the institute with TISS Research Accelerator Grants. The grants, which support new ideas and promote innovation and interdisciplinary research in sport science and sport medicine, will provide each team with $120,000 for their research project to be completed over two years.

“I’m very gratified that our first cycle of TISS Accelerator Grants attracted the attention of excellent groups of sport medicine and sport sciences researchers,” said TISS director Ira Jacobs, a professor at KPE. “I will be equally excited to learn about the new knowledge and innovation their work generates over the next couple of years.”

These are the awarded research projects.

Athlete concussion surveillance in Special Olympics Sports

“Athletes with intellectual disability (ID) have been severely underrepresented in concussion research, education and care,” says principal investigator Kelly Arbour‐Nicitopoulos, an associate professor in the Faculty of Kinesiology and Physical Education (KPE) at the University of Toronto (U of T) with expertise in adapted (disability) physical activity and psychology. “This project brings together leaders in the Special Olympics (SO) Canada community and concussion and disability research to co‐create a feasible solution to the current lack of standardized assessment and surveillance of concussion in SO sports.”

The study objectives are: 

•    To develop and pilot a SO athlete concussion surveillance tool that can enable coaches and medical staff to capture concussion injury, demographic and sport characteristics, and
•    To surveil Canadian SO competitive athlete concussion incidence and history. 

Phase One will use the nominal group technique, a structured method for group brainstorming that encourages contributions from everyone, to gather feedback and consensus from five medical staff and five coaches on the items to be included within a prototype SO concussion surveillance tool. The PRIVIT injury tracking tool will serve as the technology and the collected concussion information will be adapted based on the group’s consensus. 

Phase Two will use prospective and retrospective approaches to pilot the implementation of the surveillance concussion tool at four large multi‐day SO competitions. These Games will include 2300+ SO athletes across a range of SO sports. Onsite survey data collection will occur with 360 caregivers to capture retrospective concussion history while focus groups with a subgroup of 16 medical staff and 16 coaches will be conducted to gain an understanding of their experiences with using the surveillance tool. 

Phase Three will support knowledge translation and dissemination activities to enhance the uptake of the study findings among the SO and sport science community.

The co-principal investigator of the research project is Nick Reed, an associate professor at the Temerty Faculty of Medicine in the department of occupational science and occupational therapy, with Emily Bremer, an assistant professor in the School of Kinesiology at Acadia University and Canada Research Chair in Healthy Inclusive Communities, and Michael Hutchison, associate professor at KPE with expertise in sport concussion and rehabilitation, as co-investigators.

They will also collaborate with Tom Davies and Kendra Isaac from Special Olympics Canada, and the Centre for Sport‐Related Concussion Research, Innovation and Knowledge on this project.

Gymnast wrist injury prevention program (G-WIPP)

Nearly 88 per cent of gymnasts experience wrist pain during their careers, with particularly high forces applied during floor, pommel and vault events. Furthermore, 10 per cent of adolescent gymnasts experience an injury to the growth plates of the radius and/or ulna, the two bones in the forearm - this is called the Gymnast Wrist (GW). 

Contributors to GW include early age of sports specialization, high volume of repetitive training and peak levels of training that often correspond with the adolescent growth spurt. Growth arrest from repetitive loading causes painful deformity and/or unstable wrists that can necessitate lengthy time off sport, surgical correction (in three per cent of athletes), or even early retirement.

“While these risks are well established, definitions of safe wrist loading intensity and volume remain vague for these young athletes,” says principal investigator Andrea Chan, an assistant professor in the U of T divisions of orthopaedic and plastic surgery, and pediatric/adult hand & wrist surgeon at Toronto Western Hospital and Hospital for Sick Children. “There are no evidence‐based objective guidelines to help athletes, coaches and their medical team navigate acceptable levels of training during peak growth velocity nor how to guide treatment and rehabilitation scientifically.”

The ultimate goal of the Gymnast Wrist Injury Prevention Program (G‐WIPP) is to develop high‐level evidence‐based recommendations to inform the best clinical practice for safe levels of wrist loading, including volume, intensity and load, during peak growth velocity. 

The research team will produce a position statement on Gymnast Wrist, which will outline key risk factors and predictors for wrist injury; operationalize an effective evidence‐based Gymnast Wrist risk reduction program, which will include educational tools, a novel athlete‐accessible biometrics app for tracking growth, and specific bracing recommendations; and lastly, inspire engagement in healthy and safe gymnastics participation.

Chan will be collaborating on this project with Ryan Paul, assistant professor in the U of T divisions of orthopaedic and plastic surgery, and adult & sports hand & upper extremity surgeon at Toronto Western Hospital, Timothy Burkhart, an assistant professor at KPE specializing in orthopaedic biomechanics, and John Theodoropoulos, an assistant professor of orthopaedics at U of T, Dovigi orthopaedic sports medicine chair at Mount Sinai Hospital and orthopaedic surgeon at Women’s College Hospital. 

Sleep apnea in Paralympic Ontario-resident athletes with spinal cord injury (SPORTS) study

Spinal cord injury (SCI) can be a catastrophic event for individuals who may sustain motor,
sensory and autonomic deficit, which occurs when the autonomic nervous system, which controls functions responsible for well-being and maintaining balance, does not regulate properly. 

SCI often causes multiple secondary health conditions, including sleep apnea that is found in up to 50 per cent of the individuals with paraplegia, a symptom of paralysis that mainly affects your legs, and up to 91 per cent of the individuals with tetraplegia, a paralysis caused by an injury of the cervical spinal cord. 

“Although the frequency of sleep apnea after SCI is much higher than in non-disabled people, this condition is still largely understudied, underrecognized and under-treated in the SCI population,” says principal investigator Julio C. Furlan, an associate professor at the Temerty Faculty of Medicine, staff neurologist and  clinician investigator at Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, and scientist at KITE Research Institute.

In the general population, untreated sleep apnea has been linked with an increased risk of stroke, heart attack, heart rhythm problems, diabetes and kidney disease. Untreated sleep apnea has also been associated with several psychosocial, neurocognitive and behavioral consequences affecting individuals’ quality of life, well-being and performance in recreational and professional sports.

“We hypothesize that continuous positive airway pressure (CPAP) for treatment of moderate-to-severe sleep apnea in high-performance athletes with SCI will alleviate fatigue, depressive symptoms, anxiety and cognitive impairment, thereby improving their work and social participation, and quality of life, as well as improve their performance and perceived risk of injuries,” says Furlan.

This two-year novel research project will include a single-arm clinical trial to evaluate the efficacy of CPAP in the management of moderate-to-severe sleep apnea among high performance athletes with SCI who have moderate-to-severe sleep apnea; and a qualitative analysis that will entail face-to-face interviews to identify the perspectives of athletes with SCI who undergo CPAP therapy, and their perceptions about the risk of sports related injuries.

Working with Furlan on this research project are Mark I. Boulos, an associate professor at the Temerty Faculty of Medicine, staff neurologist and associate scientist with subspecialty in sleep and stroke neurology at Sunnybrook Health Sciences Centre, Kimberly Coros, an assistant professor of physical medicine and rehabilitation in the department of medicine at the Temerty Faculty of Medicine, staff physiatrist at Bridgepoint Active Healthcare – Sinai Health Systems, sports medicine physician at the Canadian Sport Institute Ontario, and member of the board of directors of the Canadian Academy of Sport and Exercise Medicine, Sivakumar Gulasingam, an assistant professor at the Temerty Faculty of Medicine, with expertise in spinal cord medicine and sports medicine, staff physiatrist at Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, and chief international classifier of para athletics for the World Para Athletics (WPA) and International Paralympic Committee (IPC), Martha McKay, a staff psychologist and clinical neuropsychologist in the spinal cord program at Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, with expertise on mental health in individuals with disability including spinal cord injury, Sandra Walsh, a staff registered respiratory therapist and certified respiratory educator in the spinal cord program at Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, with expertise on respiratory dysfunctions and sleep-related breathing disorders in individuals with spinal cord injury, Joel Greenshields, manager of research, data and technology solutions at the Canadian Sport Institute Ontario, specializing in exercise physiology, statistics and sports performance applications, Melissa Lacroix, a sport scientist and current Integrated Support Team (IST) lead, physiologist with Wheelchair Rugby Canada and  senior manager for high performance with Tennis Canada, and Amie Bouley, a registered nurse who developed paraplegia after a spinal cord infarct, followed by secondary medical conditions including sleep apnea. 

Recombinant human growth hormone (rHGH) for early patellofemoral osteoarthritis: A pilot,
randomized placebo-controlled trial

Patellofemoral arthritis, a common cause of anterior knee pain, affects 3.9 million Canadians. Treatments range from weight loss to total knee arthroplasty, a surgical procedure to restore the function of the joint. 

“The treatment option for young adults with mild to moderate arthritis mostly reduce symptoms, rather than reverse the disease process,” says principal investigator Ajay Shah from the division of orthopaedic surgery in the department of surgery at the Temerty Faculty of Medicine. “Identifying a treatment regimen that improves biomechanics and strength can empower patients to have high self‐efficacy when facing previously untreatable disease.”

The research team will conduct a pilot blinded randomized trial, the gold standard for safety and efficacy in establishing a novel treatment. Patients will be randomly assigned to treatment arms and receive
either high growth hormone (HGH) or placebo alongside therapy for six weeks. At up to 12 months, the team will test for muscle strength, administer surveys and analyze imaging. 

This study protocol is similar to previously published trials studying HGH in other populations. HGH has recently been shown to help with recovery after acute injuries, but this is the first study to apply it to arthritis treatment.

The researchers expect a primary outcome to be increases in patients' thigh and hip muscle strength, measured using a computerized machine. The primary question will be whether six weeks of HGH improves knee extension (quadriceps) strength compared to placebo at six months in patients with patellofemoral arthritis participating in a physical therapy program. The team will also survey patients’ symptom severity and quality of life, and assess arthritis progression and gait changes, which are all abnormal in patellofemoral arthritis. 

“This small trial will first establish if HGH is safe to use, and the next steps would be a large trial that enrolls patients from multiple hospitals,” says Shah. “Eventually, HGH and similar medications could be common treatments for osteoarthritis. Future studies could also continue to explore the ability of HGH to regrow cartilage.”

Co-investigators of this research project include Bheeshma Ravi, Sebastian Tomescu and David Wasserstein affiliated with the division of orthopaedic surgery, in the department of surgery at the Temerty Faculty of Medicine and Sunnybrook Health Science Centre, and the Sunnybrook Research Institute, Timothy Burkhart, an assistant professor of orthopaedic biomechanics from KPE, Michael Catapano from the division of physical medicine and rehabilitation in the department of medicine, at the Temerty Faculty of Medicine, Sunnybrook Health Sciences Centre, Sinai Health System, and the Sunnybrook Research Institute, Cari Whyne from the Sunnybrook Research Institute and David Lawrence from the Dovigi Orthopaedic Sports Medicine Clinic in the Sinai Health System.

Building capacity for the delivery of mental health care among elite youth athletes: A youth and family engaged approach

Elite youth athletes train and perform in highly competitive, specialized sport environments during
youth and adolescence, facing similar demands as adult athletes despite being developmentally
different from adult athletes. Additionally, research shows that in Canada, young people are more likely to experience mental disorders than any other age group, and the peak age of onset of mental
disorders occur during the mid‐teen years

“Given that early detection and intervention is key to addressing mental health concerns in young people and for optimizing elite athletes’ well‐being and mental health, it is critical to improve
our understanding of elite youth athletes’ experiences of mental health,” says principal investigator Katherine Tamminen, an associate professor at KPE and registered psychotherapist with expertise in sport psychology, mental health in sport/elite athletes, youth sport & parental influence among adolescent athletes. “Additionally, parents’ involvement in help‐seeking for their elite youth athletes’ mental health concerns has received little research attention to date.”

This project will adopt a youth‐ and family‐engaged approach to develop and implement research that is co‐designed with elite youth athletes and parents to: 

•    build capacity for research activities
•    identify priority research areas
•    develop a research plan with youth and families, and
•    conduct an initial examination of key concerns and problems in seeking help for mental health among elite youth athletes and their parents. 

The research will be the first of its kind to examine the issue of mental health among elite youth athletes and will serve as a model to develop effective approaches to support elite youth athletes and their parents in seeking support for mental health concerns.

Tamminen’s co-investigators include Courtney Walton, an academic fellow in the Melbourne School of Psychological Sciences at the University of Melbourne and registered psychologist trained in sport and exercise psychology, Jo Henderson, a professor in the department of psychiatry at the Temerty Faculty of Medicine and director of the Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health at the Centre for Addiction and Mental Health, Jordan Sutcliffe, a postdoctoral fellow at KPE with expertise in sport psychology, family dynamics in sport, mental health and wellbeing in sport and group dynamics, Rosemary Purcell, a professorial fellow in the Centre for Youth Mental Health (CYMH) at the University of Melbourne, director of knowledge translation at Orygen, Australia’s National Centre of Excellence in Youth Mental Health, registered psychologist and member of the International Olympic Committee’s mental health working group.

Evaluating neuroinflammation in athletes with concussion

Concussion is a common and debilitating form of traumatic brain injury (TBI) affecting millions worldwide. Although its acute symptoms often resolve within a few weeks, 10 to 20 per cent experience long‐ lasting symptoms such as headache, anxiety, depressions and problems with concentration and memory. The long‐term health‐related effects of multiple concussions have become a growing concern as concussions have been associated with dementia, Parkinson’s disease, attention deficit disorder, mood impairments and chronic traumatic encephalopathy (CTE) in former contact sports athletes. 

“There is increasing evidence that inflammatory changes can occur in all traumatic brain injury including mild (mTBI) and concussion,” says Carmela Tartaglia, an associate professor in the Tanz Centre for Research in Neurodegenerative Diseases at the Temerty Faculty of Medicine, and cognitive neurologist and investigator in the Canadian Concussion Centre of the Krembil Brain Institute at the University Health Network. “A better understanding of the role of neuroinflammation in concussion could help prognosticate on outcome and reveal new avenues of treatment.”

The researchers aim to overcome the challenge of variability in the results of existing studies of inflammatory mechanisms in concussion by evaluating a large number of inflammatory markers in athletes with concussion in the acute phase. The overarching aim is to better understand the role of neuroinflammation in concussion and persisting symptoms of concussion patients. 

“We hypothesize that inflammatory abnormalities can be detected in mTBI and allow differentiation from musculoskeletal controls,” says Tartaglia. “To test our hypotheses, we will use novel technology to quantify 737 inflammatory proteins in plasma, to compare inflammatory profiles between patients with concussion and musculoskeletal controls, as well as assess their prognostication capability and relationship to neurodegeneration markers.”

Michael Hutchison, associate professor at KPE and director of sport-related concussion research, innovation and knowledge, and Charles Tator, neurosurgeon in the University Health Network, clinician scientist in the Krembil Brain Institute, and director of the Canadian Concussion Centre at Toronto Western Hospital, are co-investigators on this research project.

The chronic ACL deficient “CAD” knee: Establishing a multidisciplinary collaborative to keep these athletes in the game

An athlete with a chronic ACL deficient (CAD) knee has failed previous ACL reconstruction (ACLR) or presented with the condition more than six months after injury due to treatment/diagnosis delay or failure of non‐operative management. 

“A CAD knee has additional cartilage injury and changes to bone and other ligaments, which are not seen in recent ACL injury leading to poorer outcomes with the classic paradigm of performing ACLR,” says principal investigator of this research project Timothy Burkhart. “There is a need for novel treatment approaches.”

The TISS accelerator funding will be used to:

•    Create a university‐wide shared CAD knee registry containing baseline patient information including physical examination, patient reported outcomes and imaging with the goal of providing pilot data for future clinical studies
•    Develop a cadaveric model of the CAD knee. 

The researchers will take 10 knee specimens and section the ACL. They will then use a material testing and pressure inducing machine to simulate playing sports on an ACL deficient knee in order to induce the secondary anatomic changes characteristic of the CAD knee. 

“Having a model to study the CAD knee will open doors to examine alternative treatment options to the classic paradigm of ACLR,” says Burkhart. “Currently, there is no such model in existence, but once a validated model is achieved with TISS accelerator funding, we will be able to pursue peer‐reviewed funding from external granting agencies to examine novel treatment approaches.”

The funding will also facilitate the career development of a UofT collegiate track athlete (Kosaran Gumarathas), who has been accepted to the Institute of Medical Science MSc program to complete the above study.

Burkhart will be collaborating on this research project with Sebastian Tomescu and Jaskarndip Chahal, from the division of orthopaedic surgery in the department of surgery at the Temerty Faculty of Medicine and Women’s College Hospital, Michael Catapano and Paul Marks, from the division of orthopaedic surgery in the department of surgery at the Temerty Faculty of Medicine and Sunnybrook Health Sciences Centre, Kosaran Gumarathas from the Institute of Medical Science at the Temerty Faculty of Medicine, David Wasserstein, David Lawrence and Daniel Whelan, from the division of orthopaedic surgery at Women’s College Hospital  and St. Michael’s Hospital.