As one of the first organisations to recognise and react to the urgent need to address head injury in sport, The Drake Foundation has become a central player in the fast-developing debate over how to best protect players at all levels from the devastating later-life impact of neurodegenerative disease.
Established by philanthropist James Drake in 2014, in the wake of an injury to then-Tottenham Hotspur goalkeeper Hugo Lloris during which he was knocked unconscious during a match but was allowed to carry in playing, the organisation is committed to delivering the research which will hold the key to making change.
The Foundation has been behind some of the most significant research projects to date in uncovering the impact of head injury in sport, including the Drake Rugby Biomarker Study, the first of its kind to make use of advanced neuroimaging.
The landmark BRAIN and HEADING projects – which investigate the impact of concussion in former players aged 50 and over in rugby and football respectively – are both helping to shed new light on links to neurodegenerative disease.
Over £2million has already been invested in research by the Foundation, which describes itself as being at the intersection between sports, science and society, to not only improve sports player welfare but also to advance knowledge and understanding of the brain and brain diseases in sport and across society as a whole.
Further pioneering projects are now underway, including one with retired rugby players from the pre-professional era, the findings of which could help shape the adaptations needed to properly protect players in the game in its current form.
And the need for such research is vital in helping to understand what happens in players’ brains so action can be taken to protect current and future players, says Lauren Pulling, CEO of The Drake Foundation.
“Over the last couple of years we’ve really seen the conversation on this topic shift and more people are now invested in it, it’s not just a concern for retired players who were playing decades ago, it’s a very real concern for everyone whether they’re a youth player now, whether they’ve recently retired from elite sport or whether they’re an amateur player,” she tells NR Times.
“It’s now become a conversation everyone is involved in so it’s really critical we have more research and ongoing research in this area to really pinpoint exactly what is happening in the brain, but alongside that so that sports governing bodies can take real action as well.
“While it’s going to take a while to build the full picture of what’s happening in the brain, we need to be making significant changes to pre-emptively and universally reduce players’ exposure to head impacts.
“When you know more what the actual cause is you can target that, which will help governing bodies with any protocol changes to make sport safer.”
Already, the Foundation’s research has produced some worrying findings, with its Rugby Biomarker Study revealing that almost a quarter – 23 per cent – of current rugby players sampled had abnormalities in white matter of vasculature of their brain.
While some moves are being made to tackle the issue of player safety, based on the research that exists to date – including the limit on full-contact training in rugby and restriction on high-force heading in football training – the Foundation is keen to see more action taken, backed by enforceable laws from governing bodies.
“I think for players to feel safe and youth players going into the game to feel safe, there need to be universal enforced law changes that minimise their cumulative exposure to head impacts, not just in the game but in training as well,” says Lauren.
“We want to see more from sports governing bodies. We’re really pleased to see recent changes to guidelines like the limit on full contact training in rugby and guidance to reduce heading in football in training in particular – but we’d question whether it could go even further.
“I think we need to stop being tentative and go for enforced law changes rather than guidance.”
The need for such action is becoming ever-more apparent, with players of all levels speaking out about their concerns around participation.
“We did some market research at the beginning of this year with amateur players and the parents of youth players in both football and rugby, the results of that were really concerning,” says Lauren.
“Two thirds of parents and amateur rugby players were concerned about the long-term impact of the sport on their brain health around half of parents and players in football wanted to see a reduction in heading.
“Seeing that people are that concerned, and that’s what the attitude is not just in elite sport but in the amateur grassroots game, that tell us action needs to be taken before not just more players are affected, but also for the future of the game.
“If people are dropping out then what does the future of sport look like? So I think we need to make some big changes to protect the players and the game so we don’t see another generation of this happening.”
In addition to its ongoing research, the Foundation also sees collaboration as being key to change being made around head injury in sport. Its symposium meeting brings together researchers, sports governing bodies, medical experts and other stakeholders in the debate to continue to drive the issue forward.
“There’s definitely a shift to everyone moving towards the same direction now, what we’re doing with our symposium is trying to unite that even more,” says Lauren.
“With COVID it’s been tricky to get everyone in a room and talk about the direction we’re going in, but with our symposium this year there will be a renewed focus on everyone going in the same direction, taking a united approach to tackling this issue.
“I think there’s likely more that could be done and that’s something that we are always on the lookout for. I think it will be interesting to see in light of the Government inquiry the effect that will have on uniting all the stakeholders in this field.”
Going forward, in addition to the research and collaboration, technology is playing in increasingly central role in the issue. In addition to the advanced neuroimaging which is helping The Drake Foundation in its research, innovations including a mouthguard with a sensor which can deliver real-time information to medical teams on the sidelines, are helping to provide quantifiable statistics which will help to inform research further still.
“Technology has a huge role to play in it all, in the seven years The Drake Foundation has been in this field, technology has advanced hugely,” says Lauren.
“The advanced neuroimaging that was used in the Drake Rugby Biomarker Study wasn’t part of the original proposal for that study nearly seven years ago, it has been brought along as the study progressed and I think that could turn into a really valuable tool, looking at changes to microstructures to the brain that can’t be picked up by standard MRI.
“What we don’t know at the moment are the long-term changes to white matter or vasculature so that will be a really interesting one to follow over the next few years, there is no short cut there so we need longitudinal studies using advanced neuroimaging.
“And on the sensor side, I think big data has done a lot, not just in this field but in science and medicine, so I think the more data we can gather can only be a good thing.
“What is important is how the data is then used whether it’s all put into one big data set, can we use that as a common data set, is the data comparable across different studies and sports, that will be an interesting one to see over the coming years.”
New light shed on Brazilian Jiu-Jitsu and brain injury
Athletes may be at less risk of causing long-lasting injury than has previously been feared, new research has revealed
Brazilian Jiu-Jitsu (BJJ) athletes may be at less risk of causing long-lasting injury to the brain than has previously been feared, new research has revealed.
BJJ is a popular martial art that exposes participants to recurrent intermittent asphyxiation due to controlled application of neck chokes.
Unlike several combat sports, BJJ categorically prohibits strikes to the body, especially the head, favouring limb manipulation and neck chokes to coerce an opponent into submission.
However, concerns have been raised regarding the potential link between repetitive neck chokes, structural brain damage and implications for cognitive function.
But now, in the first study of its kind, researchers at the University of South Wales (USW) – who have previously led pioneering research to show the extent of rugby players’ cognitive decline in just one season – have shed new light on BJJ.
The team from the Neurovascular Research Laboratory at USW examined blood flow to the brain using Duplex ultrasonography and cognitive function via neuropsychological tests in elite BJJ athletes.
They found preliminary evidence that the BJJ athletes had a higher resting blood flow to the brain, alongside intact cognitive function, when compared to a control group of athletes matched by age, gender, and cardiorespiratory fitness.
Benjamin Stacey, lecturer in clinical science, said: “The popularity of BJJ is growing exponentially and is likely attributable to many people witnessing its effectiveness in Mixed Martial Arts (MMA) on promotions such as the Ultimate Fighting Championship (UFC) and Bellator.
“The inclusivity of BJJ allows for all individuals to train together, regardless of age, sex or physical ability and when compared to other combat sports, BJJ carries a lesser risk to injury.
“Our unique findings argue against the notion that BJJ predisposes an individual to greater risk of long-lasting brain damage and conversely, provides evidence for enhanced protection for the brain.
“These observations may be attributed to choke-induced pre-conditioning and/or exposure to BJJ-specific high-intensity interval training, which we know can confer protective benefits for the brain.
“These findings can help to inform much-needed follow-up research to extensively examine both the short and long-term implications of participation in the sport.”
Can VR help with sight problems after brain injury?
The development of new immersive game-based technology could help with visual neglect, researchers believe
Research is underway to discover the role virtual reality (VR) could play in the rehabilitation of sight after traumatic brain injury.
TBI can have significant impact on vision, causing impaired visual attention – also known as visual neglect – even when there is no injury to the eye.
Individuals with visual neglect lose the ability to explore the full extent of their surroundings and have difficulty reading, locating personal belongings, finding their way to destinations, and many other daily activities.
Visual neglect is caused by disconnected neural networks and has been studied extensively in stroke but remains largely unexplored in other types of brain injury.
Now, Kessler Foundation is embarking on a two-year study, A Virtual Reality (VR) Exercise for Restoring Functional Vision after Head Trauma, to look into how technology can assist.
The project uses immersive VR technology developed with the armed services and provided by Virtualware, an award-winning VR technology company based in Spain.
The to-be-developed treatment is an intensive, game-like rehabilitation program leveraging a combination of VR and eye-tracking technologies to implement an oculomotor exercise protocol based on smooth eye pursuit.
Dr Peii Chen, senior research scientist in the Center for Stroke Rehabilitation Research at Kessler Foundation, said: “Our study will fill this knowledge gap by exploring visual neglect in TBI and developing a new treatment modality.”
Smooth eye pursuit exercise is an evidence-based treatment that improves patients’ ability to move their eyes toward the neglected side of space and voluntarily pay attention to the entire workspace relevant to a given task.
This ability is fundamental to spatial explorations that are required in learning, reading, and way finding.
Conventionally, smooth eye pursuit exercise for treating visual neglect requires intensive and close supervision from therapists. VR technology combined with eye tracking can reduce therapist burden.
Research participants will experience a VR session of smooth eye pursuit exercise and share their feedback.
The study will reveal the feasibility and benefits of applying new technologies to rehabilitative treatment activities.
Research participants will also undergo functional and structural neuroimaging studies of the brain.
The study outcomes will broaden the understanding of spatial processing and visual cognition as functions of brain connectivity and advance the development of treatments targeting head trauma-related visual dysfunction.
“Knowledge gained from this clinical study will advance patient care by identifying the neural basis of visual neglect due to TBI at rest and during smooth pursuit eye exercise,” said Dr Chen.
“Reaching our goals will lead to improved visual health and quality of life for civilians, as well as active-duty military and veterans with trauma-related visual dysfunction.”
Dr Chen has been awarded a $376,109 grant from the US Department of Defense, US Army Medical Research & Development Command, Congressionally Directed Medical Research Programs (CDMRP), Vision Research Program.
Consequences of repetitive head impacts in sport laid bare
Players experience an array of consequences through the cumulative effect of impacts over a decade, new study finds
Sports players with at least ten years’ experience of contact sport are experiencing an array of health consequences as a result of repetitive head impacts, a new study has found.
While they may appear healthy, research has established that athletes have problems with inflammation, energy production and coordination.
These are as a direct result of the head impacts they experience, Northwestern Medicine and Pennsylvania State University report.
The head impacts individually may not have been severe enough to cause a clinical concussion, but show the cumulative effect of repeated blows to the head over several seasons.
The issues were found in measures that show abnormal regulation of inflammation, less coordinated movement and abnormalities in how cells produce energy, and add further to existing research showing the long-term impact of head injury in sport.
These three measures are significantly related to each other before the football season and to changes observed across the football season. They were also related to the number of head impacts a player received over the season.
“These findings support over a decade of reports about the negative effects of repetitive head impacts, along with studies of animal brain injury,” said co-senior author Dr Hans Breiter, professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine.
“At this point, it appears the canary is dead in the coal mine.”
“This problem affects much of youth and professional impact sports in the US, along with training of US military personnel,” said co-senior author Dr Semyon Slobounov, professor of neurosurgery at Penn State College of Medicine.
This study – which assessed college American Football players – used measures previously found to be increased in football players before the season began and at a level similar to what is observed in individuals needing hospital treatment for a concussion.
These measures have been associated with inflammation regulation and were increased over the course of the football season. In this study, these regulatory measures of inflammation were linked with measures of energy production and coordination.
The football players’ coordination – measured as accuracy maintaining balance, speed at correcting balance and ability to remember movements – related to measures indicative of energy production issues and inflammation regulation.
Before and during the season, the higher the regulatory measures of inflammation were, the lower the coordination measures.
The study of repetitive head impacts in sport also showed abnormalities in energy production, resulting in decreased energy. These abnormalities linked abnormal inflammation regulation with reduced coordination. They also showed relationships with measured head impacts.
“A lack of energy can have significant consequences, especially in regard to brain function, raising questions of the long-term consequences,” said co-lead author Sumra Bari, a postdoctoral fellow at the department of psychiatry and behavioral sciences at Northwestern.
To perform this study, 23 athletes from a collegiate football team were enrolled who had been playing football for an average of 11 years. The athletes participated in a full season of competitive collegiate play.
Nine of them had experienced one to two concussions in prior seasons. Blood was collected and coordination was tested both before and after the football season.
The coordination tests were designed to assess balance and to test their ability to remember a virtual pathway – collectively referred to as “coordination.”
In addition, head impacts were recorded at all practices across the season using sensors which were attached to the players’ helmets.
Future research should expand to a larger cohort of athletes to confirm the findings, scientists said.
“Ultimately, the goal is to develop preventative interventions that minimise abnormal changes in the brain that have been observed in studies of contact sport athletes time and time again,” said lead author Nicole Vike, a postdoctoral fellow at the department of psychiatry and behavioral sciences at Northwestern.
“Collectively, we need to use interdisciplinary approaches, like those used here, to better quantify the unseen damage of contact sports.”
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