Brain fog and other neurological symptoms seen in those recovering from COVID-19 may be due to post traumatic stress disorder (PTSD), new research has revealed.
Growing numbers of people recovering from the virus are reporting factors including lapses in concentration, headaches, extreme fatigue and sleep disruptions – all of which can be exacerbated among brain injury survivors, many of whom experience such factors in their everyday lives without the effect of COVID-19.
Specific rehabilitation and resources are being identified for those with brain injuries, whose symptoms have worsened, often significantly, in the aftermath of contracting the virus and the rise in ‘Long Covid’ making recovery increasingly difficult, particularly among those with existing conditions.
However, a new report has revealed that ‘brain fog’ and other effects in those recovering from COVID-19 could be attributed to PTSD, an associated impact seen in previous Coronavirus outbreaks of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS).
The paper – ‘Post-traumatic stress disorder: a differential diagnostic consideration for COVID-19 survivors’ by Erin T Kaseda and Andrew J Levine – studied data from survivors of such past serious respiratory conditions, which also had neurological consequences.
“The idea is to raise awareness among neuropsychologists that PTSD is something you might want to consider when evaluating persistent cognitive and emotional difficulties among COVID- 19 survivors,” says Dr. Levine, after revealing the findings of the paper in The Clinical Neuropsychologist.
In the case of COVID-19, the paper found, symptoms of PTSD may arise in response to the invasive measures needed to treat patients, including intubation and ventilation. Other times, delirium causes patients with COVID-19 to suffer hallucinations, and the memory of these terrifying sensations continues to plague the recovered patient.
For some people, the anxiety of coping amidst a pandemic, isolation from loved ones and friends, and battling the constant fear of contracting the virus can similarly impact on thinking and memory skills – again, symptoms compounded in the instance of brain injury.
“Once (COVID-19 patients) have treatment, and hopefully have some remission of their psychiatric symptoms, if the cognitive complaints and the deficits on neuropsychological tests are still there, then that’s more evidence that something else is going on,” says Erin, who began investigating this area based on her experience of working with patients with mild traumatic brain injury, including concussion.
If the symptoms are due, even in part, to a psychiatric condition such as PTSD, treatment will help manage those symptoms, and provide a clearer view of any underlying brain issues, the report states.
“We don’t actually know anything yet from survivors of COVID-19,” Erin says. “Until we have that data, it’s very hard to say what actual percentage of patients are going to have cognitive complaints because of direct effects of the virus, because of medical intervention, or because of psychiatric concerns.
“It’s going to be important for clinicians across the board to be keeping up with the literature that’s coming out, to make sure they have the most up to date information as these survivors are starting to present for neuropsychological testing,” she adds.
New cycle helmet test discovers true level of protection for cyclists
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.
Calvert Reconnections strengthens senior team ahead of opening
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.”
UFC adopts concussion protocols for MMA fighters
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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