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Brain injury

COVID-19 ‘does not infect the brain’ but can still have serious neurological impact

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Coronavirus probably does not directly infect the brain but can still inflict significant neurological damage, new research has revealed. 

The study into SARS-CoV-2, the virus that causes COVID-19, is the largest and most detailed brain autopsy report published to date in the wake of the pandemic, and suggests that the neurological changes often seen in these patients may result from inflammation triggered by the virus in other parts of the body or in the brain’s blood vessels.

“There’s been considerable debate about whether this virus infects the brain, but we were unable to find any signs of virus inside brain cells of more than 40 COVID-19 patients,” says Professor James E. Goldman, from the Columbia University Vagelos College of Physicians and Surgeons.

“At the same time, we observed many pathological changes in these brains, which could explain why severely ill patients experience confusion and delirium and other serious neurological effects – and why those with mild cases may experience ‘brain fog’ for weeks and months.”

The study examined the brains of 41 patients with COVID-19 who died from the virus during their hospitalisation. The patients ranged in age from 38 to 97, about half had been intubated and all had lung damage caused by COVID-19. 

To detect any virus in the neurons and glia cells of the brain, the researchers used multiple methods including RNA in situ hybridisation, which can detect viral RNA within intact cells, alongside antibodies that can detect viral proteins within cells, and RT-PCR, a sensitive technique for detecting viral RNA.

Despite their intensive search, the researchers found no evidence of the virus in the patients’ brain cells, although they did detect very low levels of viral RNA by RT-PCR, which was most likely due to virus in blood vessels or leptomeninges covering the brain.

“We’ve looked at more brains than other studies, and we’ve used more techniques to search for the virus. The bottom line is that we find no evidence of viral RNA or protein in brain cells,” Professor Goldman says. 

“Though there are some papers that claim to have found virus in neurons or glia, we think that those result from contamination, and any virus in the brain is contained within the brain’s blood vessels. 

The tests were conducted on more than 24 brain regions, including the olfactory bulb, which was searched because some reports have speculated that the coronavirus can travel from the nasal cavity into the brain via the olfactory nerve. 

“Even there, we didn’t find any viral protein or RNA,” Professor Goldman continues, “though we found viral RNA and protein in the patients’ nasal mucosa and in the olfactory mucosa high in the nasal cavity.” 

Despite the absence of virus in the brain, in every patient the researchers found significant brain pathology, which mostly fell into two categories.

“The first thing we noticed was a lot of areas with damage from a lack of oxygen,” Professor Goldman says. 

“They all had severe lung disease, so it’s not surprising that there’s hypoxic damage in the brain.”

Some of these were large areas caused by strokes, but most were very small and only detectable with a microscope. Based on other features, the researchers believe these small areas of hypoxic damage were caused by blood clots, common in patients with severe COVID-19, that temporarily stopped the supply of oxygen to that area.

Professor Goldman added that more research is needed to understand the reasons why some post-COVID-19 patients continue to experience symptoms, and the team are now examining autopsies on patients who died several months after recovering from COVID-19 to learn more.

They are also examining the brains from patients who were critically ill with acute respiratory distress syndrome (ARDS) before the COVID-19 pandemic to see how much of COVID-19 brain pathology is a result of the severe lung disease.

Brain injury

New cycle helmet test discovers true level of protection for cyclists

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The effectiveness of bike helmets in protecting against brain injuries caused by collisions at speed has been tested for the first time. 

New helmet technologies have emerged in recent years to mitigate the instances and severity of traumatic brain injury (TBI) in collisions from cycling, but the way this is traditionally tested leaves room for doubt in their findings. 

The majority of real-world cycling-based TBIs are caused by rotational forces on the brain, which are generated by the head hitting the ground at an oblique angle, mostly seen when cyclists fall or collide while moving. 

However, current methods test whether heads are protected from falls at right-angles, which happen mostly when bikes are stationary, and do not account for the rotational forces at play when cyclists fall to the ground at speed.

Now, a new Imperial College London paper has demonstrated a new simulation-enabled helmet testing technique that tests how well helmets protect heads from rotational forces.

Testing 27 different helmets in a purpose-built rig at Research Institutes of Sweden, the project found that newer technologies reduced whole-brain strain compared with older helmets. 

However, they also found that the effectiveness of newer helmets depended on their technology and location of impact – some helmets which were designed specifically to reduce rotational forces didn’t appear to accomplish their aims.

Its findings could be significant in ensuring future safety innovations in cycling helmets, the research team said. 

“The amount of people cycling since the COVID-19 pandemic began has doubled on weekdays and trebled on weekends in parts of the UK,” says lead author Fady Abayazid, of Imperial’s Dyson School of Design Engineering.

“To keep themselves safe, it’s important cyclists know the best way to protect their heads should they have a fall or collision.

“Cyclists falling from motion will most often hit the ground at a non-right-angle. These angles produce rotational forces that subject the brain to twisting and shearing forces – factors contributing to severe TBIs, which can be life-altering. 

“However, current testing standards for bike helmets don’t account for this issue, so we designed a new analysis method to address this gap by combining experimental oblique impacts with a highly detailed computational model of the human brain.”

Senior author Dr Mazdak Ghajari, also of Imperial’s Dyson School of Design Engineering, adds: “With cycling’s popularity soaring, we are seeing more requests from the public and cycling communities for a thorough review of new helmet technologies to inform their purchases. 

“However, this is hard to do without testing that accounts for rotational forces.

“Our research could help to address this gap, inform customers, improve safety, and reduce the frequency and severity of TBIs from cycling.”

The authors are now looking into testing standards for motorbike and industrial helmets and the Dyson School of Design Engineering has also just built its own rig to carry out future experimental helmet impact tests.

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Brain injury

Calvert Reconnections strengthens senior team ahead of opening

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A groundbreaking neurorehabilitation centre is helping to plan for its future even before its opening through strengthening its management team. 

Calvert Reconnections is set to open on June 21 and is set to deliver new possibilities in brain injury rehabilitation through its UK-first residential programme which combines traditional clinical therapies with physical outdoor activities. 

The centre, based on the outskirts of Keswick in the Lake District, is now making new additions to its senior team as is prepares for its long-awaited opening, which has previously been delayed due to COVID-19. 

Claire Appleton has become head of service at Calvert Reconnections with Lorna Mulholland appointed as registered manager. 

Claire, an occupational therapist, has 23 years’ experience working in the NHS and has held various community roles including in acquired brain injury, long-term neurological conditions, neurological splinting and stroke rehab.  

Five years ago, Claire moved into a management post in the NHS leading the Eden Community Rehab Team, developing strategic specialist leadership and management skills, and gaining valuable experience delivering high quality health services.

Lorna has 12 years’ specialist experience within the social care sector, principally in acquired brain injury, learning disabilities, mental health and autism. 

She has an extensive knowledge base in delivering care within a residential and supported living setting with experience in complex challenging behaviour.

Sean Day, centre director at Calvert Reconnections, says: “As part of our senior management team, Claire and Lorna have a key role to play in the delivery of our service.  

“Everyone at Calvert Reconnections take great pride in what we do and the difference we can make to people’s lives.”

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Brain injury

UFC adopts concussion protocols for MMA fighters

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An official concussion protocol has been created for mixed martial arts (MMA) fighters competing in the UFC, in a first for the sport which builds further on global efforts to safeguard sportspeople from the effects of head injury. 

The UFC Performance Institute has published its protocol, aimed at both fighters and coaches, as part of a 484-page study based on data collected between 2017 and 2019.  

Hailed as the most comprehensive MMA study ever undertaken, it details the UFC’s five-step rules around returning to the sport following concussion or TBI. 

“The goal is we really want to support the ongoing development and performance behaviours and activities in the MMA gyms in the combat community globally,” says Duncan French, the UFC’s vice president of performance. 

“We are slowly aggregating our own insights and our information here in the Performance Institute, and we want to share that. We don’t want the PI to become an ivory tower where the information is only retained for a discrete 600 roster of fighters.”

Further investigation into any different needs for female fighters will be undertaken, the vice president adds. 

“Now, we need to do more work to understand how we can potentially support the ladies if they do have a concussion,” says Duncan. 

“Because that method, that approach to return to play following a concussion in females, might need to be different.”

In the new protocol, the details its return-to-sport approach as being similar to that of the NFL, beginning with up to two days of rest, followed by two stages of no-contact workouts. 

The UFC wants fighters to use its concussion assessment tool, the SCAT5, to monitor progress, and as they improve, fighters can go from no-contact workouts to moderate contact, although still with minimal risk of head contact. 

The final stage includes a return to sparring, and the UFC PI recommends starting with one session each week with no more than three rounds of five minutes, gradually adding more over a period of four weeks until they reach two full sparring sessions of five rounds per session. 

Returning to full contact will need medical clearance, the protocol states.

“For brain injuries like concussion, even if you are feeling symptom-free, a fighter should go through all stages of a return-to-sport protocol to ensure a full brain recovery,” the report says. 

“Further, resuming activity too quickly, especially in contact sports like MMA, not only increases the risk of subsequent musculoskeletal injuries and longer recovery times but also further concussions (e.g. second-impact syndrome) which can lead to chronic neurological conditions, permanent disability and death.”

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