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Brain injury

Breakthrough in diagnosing imbalance in TBI patients

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Doctors are seven times more likely to miss cases of balance dysfunction in TBI patients

A condition that causes loss of vertigo perception and imbalance has been diagnosed in traumatic brain injury patients for the first time, which could yield breakthroughs in the development of new treatments and diagnostic tests.

Of 37 patients with acute traumatic brain injury (TBI) involved in the study, 15 were diagnosed with a newly – characterised neurological diagnosis called vestibular agnosia – a condition in the brain which results in loss of vertigo perception and imbalance.

The impact of such a condition is shown through statistics which reveal TBI patients with balance problems are twice as likely to be unemployed six months after their injury, compared to those without balance dysfunction.

The research, from Imperial College London and clinicians at Imperial College Healthcare NHS Trust, also found that these patients have worse balance problems than TBI patients without vestibular agnosia and are unlikely to experience dizziness – one of the main criteria to assess balance problems in TBI patients.

As a result, doctors are seven times more likely to miss cases of balance dysfunction in TBI patients with vestibular agnosia than in those without.

The study is the first to show vestibular agnosia in TBI patients and the researchers believe that current guidelines should be updated to include screening and laboratory tests for TBI patients for vestibular agnosia so that it can be diagnosed and managed at an earlier stage.

“Imbalance affects a majority of TBI patients leading to them having falls fairly frequently,” says study lead Dr Barry Seemungal, consultant neurologist at Imperial College Healthcare NHS Trust and honorary senior lecturer in the Department of Brain Sciences at Imperial College London.

“It can affect patients’ physical and mental wellbeing, as well as affecting patients financially as it can make it hard for them to return to work post treatment.

“Some of these adults also have to support a family or care for elderly patients, meaning the knock-on effect of ill-health in this group is multi-generational. Frequent falls in this patient group also have a financial impact on the NHS due to frequent readmissions to hospitals.

“Our study is the first to identify loss of vertigo in some TBI patients and explain why they have balance problems and falls. This finding could lead to the development of new treatments and diagnostic tests.

“Importantly, current guidelines require updating so that clinicians can screen for vestibular agnosia in TBI patients at a much earlier stage as common treatable balance problems will be missed if the patients do not have access to these tests.

“We believe that diagnosing and treating these balance problems early will lead to a quicker recovery and a better quality of life for our patients.”

TBI is the commonest cause of chronic disability in under 40s and imbalance is one of the major complaints.

A key step in treating TBI imbalance is to understand the underlying causes, but previous studies could not identify a clear-cut cause in TBI patients with chronic imbalance.

Additionally, doctors looking after TBI patients only look for balance problems if patients complain of dizziness, which some patients who have frequent falls don’t experience.

Vestibular agnosia is a condition linked to both loss of vertigo perception and imbalance, due to damage to a neural circuit in the right temporal lobe of the brain.

Although vestibular agnosia can be observed at the bedside, it is most accurately diagnosed in the laboratory using a test developed by Dr Seemungal.

There are currently no specific treatments for vestibular agnosia but its recognition is important as patients may be at risk of falls and may have treatable inner ear problems, despite not complaining of vertigo.

Brain injury

PFA leaders pledge to donate brain to Concussion Legacy Project

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Two senior figures at the PFA have pledged to donate their brain to research as part of the pioneering Concussion Legacy Project to protect future generations of players. 

PFA Chief Executive Maheta Molango and PFA Chair John Mousinho have both made the pledge through a partnership with the Concussion Legacy Foundation UK, following the lead of England Rugby World Cup winner Steve Thompson.

The Concussion Legacy Project, unveiled yesterday, will research Chronic Traumatic Encephalopathy (CTE) and other consequences of brain trauma in athletes and military veterans in the UK.

PFA Chief Executive Molango, a former striker at Brighton & Hove Albion, Lincoln City and Oldham Athletic, said: “While being very mindful of taking immediate steps to protect current players, in the long-term ongoing research is vital to enable us to be able to answer more questions and best support members.

“We have been listening and engaging with leading academic experts, and they tell us that brain donation is a key piece to the puzzle in understanding CTE. We are excited to join a global network of the most prominent researchers in this area.”

Yesterday, Steve Thompson became the first athlete to pledge to the Concussion Legacy Project’s Brain Bank, with the former Lion previously stating that he cannot remember playing in England’s 2003 World Cup final win over Australia.

Today, Oxford United’s captain Mousinho, who has amassed over 500 league appearances over a fifteen-year professional career, committed his support for the project.

PFA Chair Mousinho explained: “Brain donation is an intensely personal decision for former players and their families. However, I have been inspired by the team at the Concussion Legacy Foundation and The Jeff Astle Foundation, and I have decided to commit my brain to future research in the hope that it can help play a part in protecting future generations.

“The Concussion Legacy Foundation has a strong ethos of supporting families and everyone affected by brain injury, and they are values we share at the PFA.”

Dawn Astle, who has been campaigning for two decades for football’s authorities to publicly recognise a link between the repeated heading of a football and dementia in later life, has given her full support to the new concussion initiative.

Speaking on behalf of The Jeff Astle Foundation, she said: “Brain donation is the most valuable gift of all for future generations of footballers. It may be many years before this jigsaw is complete but adding each piece, one at a time is the only way we will understand the true picture and make a better future for others.

“The Jeff Astle Foundation encourages families of athletes and veterans to donate the brain of their loved one to the Concussion Legacy Project at PledgeMyBrain.org.”

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Brain injury

‘We want to be part of the solution – for Bill and future generations’

Dr Judith Gates speaks to NR Times about this weekend’s football match organised by Head for Change, which will be the first ever to involve no heading of the ball

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The first football match which involves no heading of the ball will help raise awareness and stimulate conversation about the impact of head injury in sport, its organisers have said. 

The 11-a-side match, involving 25 former professional footballers, has been hailed as an experiment as researchers try to discover whether the game can function without heading, in light of ever-growing research which links football to neurodegenerative disease.

It is organised by Head for Change, the organisation helping to drive forward calls for changes to player safety, and will only allow headers in the penalty box for the first half and then restrict all heading during the second half. 

It will be held at Spennymoor Town Football Club, in County Durham, on Sunday at 3pm. 

The event forms part of the “legacy” for former Spennymoor Town and Middlesbrough defender Bill Gates, who has sports-related dementia, and whose wife Dr Judith Gates is co-founder and chair of Head for Change. 

Dr Judith Gates

“When Bill received his diagnosis in 2017, we made two promises to him,” Dr Gates tells NR Times. 

“One was to optimise his life and do all we could to make his life as good as we could as a dad, grandad and great grandad, and the second was for his legacy, to do everything we could to be part of the solution for future generations of footballers and their families not to have to face this.

“The purpose of this match is to raise awareness of the dangers of heading the ball and to provide alternative discussion with purpose. It’s an experiment to see what the game will look like. 

“To be clear, Head for Change is not suggesting heading should be banned, that is a decision for football’s governing authorities, not for us. 

“But we want people to realise the impact. Bill was a Titan to me in his 20s, fit and indestructible, so if this disease can do this to him, it can happen to anyone.”

The match has attracted widespread media attention and comes after an array of stark academic findings, including the research from Professor Willie Stewart that footballers are up to five times more likely to suffer from dementia than the general population. 

“Part of why I co-founded Head for Change was to be part of the solution,” says Dr Gates. 

“We’re extremely aware that there is a lot of bashing going on and everyone is saying it’s someone else’s fault, but lessons must be learnt from the past. 

“For too long we have been assured that our brain was safe in our skull, but we are increasingly understanding how the brain works and how it can be damaged through contact sports. Education will continue to play a very important role in what happens going forward.”

The match itself – which will also be raising money for The Solan Connor Fawcett Cancer Trust – will be held at Spennymoor Town’s stadium, The Brewery Field. 

The town is where Dr Gates grew up and met her husband, and in a quirk of fate, Spennymoor Town’s chief executive Brad Groves used to work for Bill as a warehouseman when Bill owned a chain of sports stores. 

The club, alongside those playing in the match, have been hugely supportive of their ambitions, says Dr Gates. 

“We’ve been amazed at the extent to which they have stepped up, Spennymoor have been phenomenal. Brad has been so kind in offering whatever he can do to help. We are hugely appreciative,” she says. 

“The players taking part are excited to be part of it, they may not be able to use one of their many footballing skills but they can use the rest of them. 

“Spennymoor is a small town with a big heart and we are so pleased to be able to hold this match, and particularly here, at Bill’s first club.”

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Brain injury

Marching to a different beat

NR Times reports on how Chroma is helping amputees prepare for prosthetics through neurologic music therapy (NMT).

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