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Brain injury

Veteran study marks new era of concussion treatment

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The shoulder of a US veteran taking part in a study on traumatic brain injury

A study has identified the first effective and highly scalable intervention to address cognitive deficits that can persist for years after a mild traumatic brain injury especially after a concussion or blast exposure.

The traumatic brain injury study utilised the computerised brain training app BrainHQ made by Posit science via Telehealth. The peer-reviewed study results were published in Brain: A Journal of Neurology.

The Department of Defense (DoD) funded the BRAVE study. It aims to determine if a computerised, brain training intervention based on the science of brain plasticity could be broadly or remotely applied. It tested to see if it could produce significant improvements in persistent cognitive defects across those with broad mild TBIs.

The study included 83 participants with a history of mild BTIs who had been diagnosed with cognitive impairment for more than seven years. These participants had typically been deployed to combat areas. Before training, they tested, on average, about two standard deviations below normal on the ANAM. The ANAM is a test used by the military to screen for cognitive impairment.

The participants were randomly placed into treatment groups (BrainHQ) and an active control group (computer games). Both activities were expected to have a positive impact due to their demands on cognitive realms such as attention, memory and reasoning. Each group self-administered the training online while at home with weekly telephone supervision from trained coaches. They were asked to train for one hour per day, five days a week over twelve weeks. This was followed by a twelve-week, no training follow-up period.

Read more: Head injuries in rugby players linked to brain structure changes

It was conducted through a network of five military and veterans’ medical centres in Bethesda, Honolulu, Houston, West Haven, Boston and with Posit Science in San Francisco.

The results showed that the BrainHQ group reported clinically significant improvement in overall cognitive function in comparison to the computer games group. The benefits lasted for at least twelve weeks after training was completed. Cognitive function was 3.9 times larger in the BrainHQ group than the control group. It was 4.9 times larger when measured again twelve weeks after training ended.

The US military have recorded more than 413,000 members who have been diagnosed with a traumatic brain injury (TBI). Of these, more than 82 per cent are classified as mild TBI referred to as a ‘signature injury’ of recent conflicts. In many cases, service members can experience a full recovery from this but for those who do not, cognitive consequences can persist for years. This can have life altering results.

Physician, Colonel (Ret.) Dallas Hack, said “When this study was selected for funding, we were hoping it would help troops impacted by mTBI. These results exceed my fondest expectations. The broad applicability, modest cost, and self-directed nature of the intervention mean it could be scaled very quickly.”

Currently, the best practice for the treatment of persistent cognitive deficits following a mild TBI focuses on in-person, customised cognitive rehabilitation. This can be helpful but is also costly and time-consuming as it requires travel for treatment and relies on healthcare expertise. No computerised cognitive training has previously been shown effective in a gold-standard trial.

Read more: Mental health NHS Trust extends roll-out of Perfect Ward

BrainHQ has been used in many military and Veterans’ facilities for cognitive rehabilitation, under the supervision of healthcare professionals. With the release of these results, Posit Science (maker of BrainHQ) has indicated it intends to work with clinicians, payors, patient advocacy groups, legislators, and administrators to make this intervention widely available, as quickly as possible.

Dr Henry Mahncke, CEO of Posit Science, said: “These are long-awaited and important results. This study provides strong evidence that this intervention could be deployed on a massive scale through military and veterans’ health facilities to meet our nation’s obligation to address persistent real (but often invisible) life-altering challenges for wounded servicemembers and veterans – even those in remote locations.”

Read more: Alzheimer’s Research UK receives diagnostics funding boost

Brain injury

PFA leaders pledge to donate brain to Concussion Legacy Project

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Two senior figures at the PFA have pledged to donate their brain to research as part of the pioneering Concussion Legacy Project to protect future generations of players. 

PFA Chief Executive Maheta Molango and PFA Chair John Mousinho have both made the pledge through a partnership with the Concussion Legacy Foundation UK, following the lead of England Rugby World Cup winner Steve Thompson.

The Concussion Legacy Project, unveiled yesterday, will research Chronic Traumatic Encephalopathy (CTE) and other consequences of brain trauma in athletes and military veterans in the UK.

PFA Chief Executive Molango, a former striker at Brighton & Hove Albion, Lincoln City and Oldham Athletic, said: “While being very mindful of taking immediate steps to protect current players, in the long-term ongoing research is vital to enable us to be able to answer more questions and best support members.

“We have been listening and engaging with leading academic experts, and they tell us that brain donation is a key piece to the puzzle in understanding CTE. We are excited to join a global network of the most prominent researchers in this area.”

Yesterday, Steve Thompson became the first athlete to pledge to the Concussion Legacy Project’s Brain Bank, with the former Lion previously stating that he cannot remember playing in England’s 2003 World Cup final win over Australia.

Today, Oxford United’s captain Mousinho, who has amassed over 500 league appearances over a fifteen-year professional career, committed his support for the project.

PFA Chair Mousinho explained: “Brain donation is an intensely personal decision for former players and their families. However, I have been inspired by the team at the Concussion Legacy Foundation and The Jeff Astle Foundation, and I have decided to commit my brain to future research in the hope that it can help play a part in protecting future generations.

“The Concussion Legacy Foundation has a strong ethos of supporting families and everyone affected by brain injury, and they are values we share at the PFA.”

Dawn Astle, who has been campaigning for two decades for football’s authorities to publicly recognise a link between the repeated heading of a football and dementia in later life, has given her full support to the new concussion initiative.

Speaking on behalf of The Jeff Astle Foundation, she said: “Brain donation is the most valuable gift of all for future generations of footballers. It may be many years before this jigsaw is complete but adding each piece, one at a time is the only way we will understand the true picture and make a better future for others.

“The Jeff Astle Foundation encourages families of athletes and veterans to donate the brain of their loved one to the Concussion Legacy Project at PledgeMyBrain.org.”

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Brain injury

‘We want to be part of the solution – for Bill and future generations’

Dr Judith Gates speaks to NR Times about this weekend’s football match organised by Head for Change, which will be the first ever to involve no heading of the ball

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The first football match which involves no heading of the ball will help raise awareness and stimulate conversation about the impact of head injury in sport, its organisers have said. 

The 11-a-side match, involving 25 former professional footballers, has been hailed as an experiment as researchers try to discover whether the game can function without heading, in light of ever-growing research which links football to neurodegenerative disease.

It is organised by Head for Change, the organisation helping to drive forward calls for changes to player safety, and will only allow headers in the penalty box for the first half and then restrict all heading during the second half. 

It will be held at Spennymoor Town Football Club, in County Durham, on Sunday at 3pm. 

The event forms part of the “legacy” for former Spennymoor Town and Middlesbrough defender Bill Gates, who has sports-related dementia, and whose wife Dr Judith Gates is co-founder and chair of Head for Change. 

Dr Judith Gates

“When Bill received his diagnosis in 2017, we made two promises to him,” Dr Gates tells NR Times. 

“One was to optimise his life and do all we could to make his life as good as we could as a dad, grandad and great grandad, and the second was for his legacy, to do everything we could to be part of the solution for future generations of footballers and their families not to have to face this.

“The purpose of this match is to raise awareness of the dangers of heading the ball and to provide alternative discussion with purpose. It’s an experiment to see what the game will look like. 

“To be clear, Head for Change is not suggesting heading should be banned, that is a decision for football’s governing authorities, not for us. 

“But we want people to realise the impact. Bill was a Titan to me in his 20s, fit and indestructible, so if this disease can do this to him, it can happen to anyone.”

The match has attracted widespread media attention and comes after an array of stark academic findings, including the research from Professor Willie Stewart that footballers are up to five times more likely to suffer from dementia than the general population. 

“Part of why I co-founded Head for Change was to be part of the solution,” says Dr Gates. 

“We’re extremely aware that there is a lot of bashing going on and everyone is saying it’s someone else’s fault, but lessons must be learnt from the past. 

“For too long we have been assured that our brain was safe in our skull, but we are increasingly understanding how the brain works and how it can be damaged through contact sports. Education will continue to play a very important role in what happens going forward.”

The match itself – which will also be raising money for The Solan Connor Fawcett Cancer Trust – will be held at Spennymoor Town’s stadium, The Brewery Field. 

The town is where Dr Gates grew up and met her husband, and in a quirk of fate, Spennymoor Town’s chief executive Brad Groves used to work for Bill as a warehouseman when Bill owned a chain of sports stores. 

The club, alongside those playing in the match, have been hugely supportive of their ambitions, says Dr Gates. 

“We’ve been amazed at the extent to which they have stepped up, Spennymoor have been phenomenal. Brad has been so kind in offering whatever he can do to help. We are hugely appreciative,” she says. 

“The players taking part are excited to be part of it, they may not be able to use one of their many footballing skills but they can use the rest of them. 

“Spennymoor is a small town with a big heart and we are so pleased to be able to hold this match, and particularly here, at Bill’s first club.”

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Brain injury

Marching to a different beat

NR Times reports on how Chroma is helping amputees prepare for prosthetics through neurologic music therapy (NMT).

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