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Global commission calls for urgent action

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Traumatic brain injury (TBI) looks likely
 to remain the largest global contributor to neurological disability until at least 2030,an international commission has forecast.

The predicted burden of disabilitysurrounding TBI across the world “far exceeds” that related to dementia and cerebrovascular disease, says the Lancet Neurology Commission’s extensive report.

The paper estimates that the global annual cost of TBI could be as high as US$400bn (£296bn), or around 0.5 per cent of gross world product.

The report aims to pave the way for what it calls a “long overdue”, concerted effort to tackle the global TBI problem, which is a “public health challenge of vast, but insufficiently recognised, proportions”.

It sets out priorities and expert recommendations for all parties involved in TBI, including healthcare professionals, researchers, funders and decision-makers.

Over 70 expert authors representing institutions spanning the globe contributed to the report, with a further 250 contributors via the International Initiative for Traumatic Brain Injury Research (InTBIR).

A lack of uniformity in the characterisation and management of TBI in different countries around the world is a continual theme throughout the report.

Among several recommendations, the report urges an international consensus on definitions and standardised epidemiological monitoring of TBI, to allow accurate measurement of key factors such as incident rates and access to care.

The report also underlines the value of centralised care, explaining: “There is growing evidence of a relationship between management in high-volume centres and improved outcomes, which suggests that care for the most critically ill patients should be centralised.

“Substantial gains could be made from provision of adequate prehospital care, appropriate referral and continuity along the chain of care, with early access to effective rehabilitation,” it adds.

The commission also calls for:
• More research into links between TBI and increased risk of later neurological diseases, such as stroke and dementia

• Better strategies for TBI prevention to deliver cost savings that could fund improved access to care and research

• Professional sporting organisations to lead by example by immediately removing anyone with a suspected concussion from play

• Healthcare policies which improve access to acute and post-acute care, reducing the burden of TBI on patients, families and society

• More “robust evidence” on potential medical, surgical and rehabilitation interventions to inform guidelines and improve outcomes

• Studies aimed at improving the precision of diagnosis, classification and characterisation of TBI

• The development of a “validated set of quality indicators” to enable the benchmarking of care quality

• Greater collaboration between public and private funding bodies – as well as industrial partners –to support the development of national and global biorepositories and databases which could foster vital TBI research

• The introduction of validated outcome measures which factor in the overall burden of disability caused by TBI, driving better clinical management and aiding the high-quality research needed to take TBI treatments forward

A dearth in TBI-relevant drug treatments is particularly concerning to the commission. It states: “Despite investment of many billions of dollars by pharmaceutical companies, no effective drugs exist for treatment in the acute setting – a failing due, in part, to insufficient targeting of therapies to patients in whom the relevant mechanism is active.

“We need better methods to characterise TBI to allow identification of patient sub-groups with a common dominant disease mechanism, who are more likely to respond to specific treatments – a concept now being popularised as precision medicine.”

It continues: “Huge opportunities exist for improvements in characterisation of initial severity, outcome and prognosis, and for more accurate tracking of disease processes, by building on the current scientific advances in modern neuroimaging, genomics, disease biomarker development, and pathophysiological monitoring.

“Developments
 in these technologies could facilitate the goals of precision medicine in TBI.”

The commission comes amid rising levels of TBI in countries of all economic status. High-income nations like the UK, with its ageing population, are experiencing more TBI caused by falls among the elderly.

In low and middle-income countries, TBIs as a result of traffic accidents are increasing, according to the report. International conflict and sports-related concussions are also adding to growing worldwide TBI rates.

The report concludes: “Clinicians and researchers, in consultation with patients and their families, need to play their part in taking these recommendations forward.

“Collaboration between funding agencies will be required to coordinate the strategy and conduct of research, and commitment from policymakers will be essential to facilitate research and ensure timely implementation of research outputs.

“Implementation of prevention strategies and provision of optimum clinical care in different settings should be a priority for clinicians and policymakers alike. Integration of all these e orts should deliver rich dividends in terms of better and more cost-effective care, with huge benefits for patients, their families, and society as a whole.”

Global TBI in numbers

US$400bn: Estimated global financial burden of TBI each year
50 to 60 million: Approximate annual number of TBIs internationally
6.5 years: The typical gap between clinical research and its translation into improvements in care (or between study publication and systematic review)
5 to 15 per cent: The possible attributable risk of dementia as a result of TBI – an area which needs more investigation, saysthe commission
30 to 40 per cent: Mortality rate of severe TBI (according to observational studies on unselected populations)
1 million: number of deaths caused by TBI each year

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No higher risk of pregnancy complications in women with MS – study

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Women with multiple sclerosis (MS) may not be at a higher risk of pregnancy complications like gestational diabetes, emergency caesarean section or stillbirth than women who do not have the disease, new research has found.

However, the study did find that babies born to mothers with MS had a higher chance of being delivered by elective caesarean section (c-section) or induced delivery, and of being small for their age when compared to babies of women who did not have the disease.

“Women with multiple sclerosis may be understandably concerned about the risks of pregnancy,” says study author Professor Melinda Magyari, of the University of Copenhagen.

“While previous research has shown there is no higher risk of birth defects for babies born to women with MS, there are still a lot of unknowns around pregnancy and MS.

“We wanted to find out if women with MS are at risk for a variety of pregnancy complications.

“We found overall their pregnancies were just as healthy as those of the mothers without MS.”

The study involved 2,930 pregnant women with MS who were compared to 56,958 pregnant women without MS. All women gave birth between 1997 and 2016.

Researchers found no difference in risk of several pregnancy complications between women with MS and women without it.

No differences were found in risk of pre-eclampsia, gestational diabetes, placenta complications, emergency c-section, instrumental delivery, stillbirth, pre-term birth, congenital malformations or low Apgar score. Apgar score is a test of a newborn’s health, including measures like heart rate, reflexes and muscle tone immediately after birth.

Researchers did find that 401 of the 2,930 women with MS, or 14 per cent, had an elective c-section, compared to 4,402 of the 56, 958 women without MS, or eight per cent, who had an elective c-section.

After adjusting for other factors that could increase the likelihood of having an elective c-section, such as prior c-section and mother’s age, women with MS were 89 per cent more likely to have an elective c-section.

Researchers also found women with MS were 15 per cent more likely to have an induced delivery than women without the disease.

Also, women with MS were found to be 29 per cent more likely to have babies that were born small for their gestational age compared to women without MS.

Overall, 3.4 per cent of women with MS had babies small for their gestational age, compared to 2.8 per cent of women without MS.

“We think the reason more women with MS have babies by elective c-section or induced delivery may have to do with MS-related symptoms such as muscle weakness, spasticity or fatigue that might affect the birth,” Professor Magyari says.

“Any of these could make a mother more tired and lead to delivery complications that could prompt the clinician and woman to take extra precautions.”

Researchers also found that mothers with MS were 13 per cent less likely to give birth to babies with signs of being deprived of oxygen, or asphyxia.

Professor Magyari said the higher prevalence of elective c-sections among women with MS most likely explains the corresponding lower odds of asphyxia.

A limitation of the study is the lack of data on the mothers’ smoking, which could cause babies to be born small for their gestational age.

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Neuro physio

Community neurorehab gym continues to expand

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The West Berkshire Therapy Centre was established on the back of £145,000 worth of fundraising

A community therapy centre which enables neuro patients access to the physio-led exercise which can support their recovery continues to expand in response to demand for its services.

West Berkshire Therapy Centre was opened in 2014 to bridge the gap in existing community resources, and initially opened for 20 hours a week with ten items of equipment.

Since that time, the Thatcham centre has expanded into premises twice the size of its initial home, and now has 17 items of equipment which clients can access 35 hours each week.

While the centre has been forced to close during lockdown periods, the investment in its offering has continued, with a further £17,500 being spent to upgrade equipment.

In addition to its regular clientele of around 260 people, around 200 more will be referred to the centre from the Berkshire Long COVID Integrated Service, led by Dr Deepak Ravindran, who has worked closely with the centre for several years.

As well as the anecdotal evidence from clients who attest the positive effect West Berkshire Therapy Centre has, the centre’s work has been proven to improve client mobility by an average of ten per cent, psychological outlook by 15 per cent and weight loss by three per cent.

All clients are assessed by the centre’s physio before being prescribed an individual exercise programme. The centre prides itself on its client-centred approach and some of the equipment in the gym has been designed and built specifically in response to what clients said were important to them.

West Berkshire Therapy Centre was created by the West Berkshire Neurological Alliance, a group of 23 local neuro charities, which recognised the need for greater specialist provision for people living with neurological conditions in the area.

John Holt was instrumental to the creation of both the Alliance and the Centre. Having supported his wife in living with MS for over 40 years, he took the lead on ensuring greater provision and support was there for those who needed it.

“I’m not from a medical background, I’m a food technologist, and while I was chair of a trade association during my career, I was used to working with competitors and business enemies, that was just what happened for the greater good of us all,” he says.

“So I was rather shocked when I got involved with the local voluntary sector and found that wasn’t the case. I was very proactive in all of our charities working together as I know the importance of working as one alliance.

“People who were living with neurological conditions were often having to fend for themselves when it came to community rehab, and that’s why we wanted to create the West Berkshire Therapy Centre.”

Having been established on the back of £145,000 in fundraising, five years later the demand for its services was such it had to expand into larger premises and invest in more equipment.

The centre – which is funded by voluntary contributions for sessions and through fundraising – now has eight part-time staff and a core of volunteers to support clients with whatever rehabilitation issues they have.

While most clients have neurological conditions – including stroke, Parkinson’s, MS and Post-Polio Syndrome – the centre has broadened its reach to include large numbers of people with arthritis, heart and lung conditions, sight impairments as well as amputees.

“We’re completely pan-disability and will support anyone who needs us. Our clients talk to us and we listen and adapt,” says John.

“I think many clients come to us because we are a safe place for them and they’re among people who understand the challenges they face.

“It is very important that we talk about things openly. For example, we talk about how hard it is when you can’t get to the bathroom in time and you wet yourself.

“When you face issues like that, it can be the start of a spiral downhill, you might then stop going to work or stop leaving the house, but we share these kinds of things.

“By having this interaction, it becomes a place people aren’t afraid to open up.”

With the centre having been closed for much of the past year, John and the team are ready to welcome back regular and new clients, including the many who are recovering from Long COVID.

“Many of our clients won’t have exercised for several months, but we hear very often that people have waited 20 years for a centre like this, so a few months hasn’t been long in comparison,” says John.

“But we are very much looking forward to re-opening and supporting our clients in regaining any progress and fitness they may have lost. Hopefully we are on the right track now after three lockdowns and clients can come back to us regularly.

“Long COVID is a new condition for us, as it has only come into being in the past few months, but we are ready to support people with their symptoms and in them using exercise as part of their recovery.”

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Brain tech company secures funding to increase support post COVID-19

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CBS Health will help clinicians utilise more digital services

An online brain assessment platform has secured funding to enable its work in telehealth to continue to support people as the world emerges from the COVID-19 pandemic.

Cambridge Brain Sciences (CBS) is planning to expand its operation through a funding round from Canadian Shield Capital, a Toronto-based private equity investment firm, closely aligned to Hatch, a global engineering consultancy.

The investment will allow Candian-based CBS to further its work in digital health, especially around mental health, and respond to the need for accurate and reliable quantified measures of brain function and brain health – hailed as being essential to so many people who have suffered psychologically from the effects of COVID-19.

The funds will allow CBS to grow its sales and customer support teams rapidly, which will enable it to roll out its flagship product, CBS Health, further.

It will also enable it to expand on CBS Health features to help continue to refine and develop its cognitive care platform for healthcare professionals treating the growing mental health, brain injury and ageing patient populations.

The COVID-19 global pandemic has seen many healthcare practitioners to adopt platforms such as CBS Health to manage patients remotely.

As a result of lockdowns and ‘stay at home’ guidance, there has been exponential growth in patients seeking treatment for mental health conditions brought on, or exacerbated by, the pandemic, as well as individuals recovering from COVID-19 suffering with longer term neurological symptoms.

CBS Health has also grown as a result, and offers a web-based platform or integration which allows healthcare professionals to administer the CBS tasks standalone or alongside other established and validated complementary assessments (such as the PHQ-9, a standard scale for assessing the severity of depressive symptoms).

Assessments can be combined into a single session and administered in person or remotely via email—an option from which clinicians have benefitted greatly throughout the COVID-19 global pandemic.

The investment also contemplates further collaboration between CBS and Hatch, building upon an earlier successful pilot for a dedicated CBS platform to address corporate workplace mental health and safety at large scale industrial operations, construction sites and infrastructure projects.

“CBS is excited to be closing this round of financing which builds upon a long-term relationship with Canadian Shield and an earlier successful pilot with Hatch,” says Marc Lipton, president and CEO of Cambridge Brain Sciences.

“The funding will allow us to further accelerate the growth of our core CBS Health product especially amongst mental health practitioners, as well as to strategically explore, with Hatch, large corporate applications for workplace mental health and safety.”

“CBS brings many years of academic discipline and rigorous digital measurement of cognitive health, with applications in mental health, brain injury recovery, healthy ageing, and soon workplace safety,” says Andrew W. Dunn, managing partner at Canadian Shield Capital.

“The growing awareness of, and attention to, mental health conditions and CBS’ engaging and efficient approach gives it enormous runway.”

James Marzocca, global managing director for project delivery at Hatch, adds: “We see great potential to apply CBS testing as a non-invasive diagnostic to assess fitness for duty for individuals reporting to worksites where mental alertness is essential for their own safety and the safety of others.”

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