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Brain injury

COVID effects on the brain study searching for participants

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Neuroscientists exploring the lasting impacts of COVID-19 on the brain are recruiting participants for a study which has been created to provide answers for healthcare professionals and improved care for millions of patients across the world.

The COVID-19 Brain Study is looking to find 50,000 people globally who received a confirmed positive diagnosis of the virus, in order to answer some of the main questions about the disease’s direct and indirect effects on the brain.

The study, which has been translated into three languages, hopes to break new ground in understanding the neurological impact of COVID-19, which so far remains largely unknown.

COVID-19 Brain Study, a collaboration between Western, the University of Toronto and Sunnybrook Health Sciences Centre, comprises three online sessions across a year, and will end in June 2021.

“The problem is a bit like when governments were deciding to enter lockdown – timing is everything,” says Dr Adrian Owen, a world-renowned cognitive neuroscience and imaging professor at the Schulich School of Medicine & Dentistry.

“We need to start collecting this data now. We can’t start looking at this issue in a year’s time because if there are cognitive impairments, and we know there will be, it’s going to be too late.”

As COVID-19 spread across the world, the international healthcare response overwhelmingly focused on diagnosis, contact tracing, containment and supportive care, in response to the rapidly-increasing numbers of cases.

Research also targeted these areas, especially on improving testing and vaccine development, but so far, little work has been done on the potential neurological effects and longer-term impacts of the disease.

That is an important gap to start spanning immediately, according to researchers.

“A year from now, we will have more than eight million people worldwide recovering from COVID-19. So we may also have eight million people with short- and long-term cognitive problems,” says Dr Owen.

For the new study, Dr Owen has partnered with Dr Rick Swartz, a stroke neurologist and cognitive scientist from Sunnybrook and the University of Toronto.

They started working together in 2011, shortly after the British-born neuroscientist moved to Western from the University of Cambridge, and have worked on various cases and research projects over the years.

The team is turning to patients to explore many unanswered questions, ranging from whether COVID-19 infection could result in significant cognitive impairment, to whether there are correlations between sex, age and medical risk factors which result in greater impact.

“We also need to understand whether COVID-19 patients are getting better or worse over time,” Dr Swartz says.

“And is it only some patients? For example, is it only those who were ventilated or sedated?

“This study will allow us to ask these relevant questions on a global scale and to inform efforts to improve recovery and long-term function for the millions of COVID-19 survivors around the world.”

Dr Owen said the pandemic has seen an unprecedented spike in ICU demand. Patients who exit the ICU can suffer from a spectrum of physical, functional and neuropsychological issues known as ‘post-intensive care syndrome’ (PICS).

In a 2019 study published by PlosOne, researchers showed that cognitive impairments in daily function are common as a result of ICU visits. Nearly all patients are cognitively impaired at the time of ICU discharge. Two-thirds are not back to their baseline function after six months and roughly half have cognitive impairment years later.

“ICU survivors are vulnerable to cognitive impairment. So, as the number of recovered COVID-19 patients continues to climb, it’s becoming increasingly apparent that getting sent home from the ICU is not the end for these people. It’s just the beginning of their recovery,” Dr Owen adds.

* To participate in the COVID-19 Brain Study, visit https://www.cambridgebrainsciences.com/studies/covid-brain-study

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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