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Brain injury

Re:Cognition Health: lifting the lid on CTE and concussion in sport

NR Times speaks to Dr Emer MacSweeney about her company’s latest work around developing objective biomarkers to accurately diagnose concussion in sport.

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Re:Cognition

When it comes to concussion one of the hardest things for clinicians to achieve is a comprehensive diagnosis.

This makes it even harder for those working in contact sports to achieve this, with time usually of the essence when an assessment is made mid-game.

Re:Cognition Health is one firm looking to make progress in this area and is doing so through a number of technological innovations.

Recently the company has taken a particular focus on creating a device that can diagnose one of the most common conditions brought on by contact sports in chronic traumatic encephalopathy (CTE).

This is a gradual condition which develops after repeated blows to the head, which starts with symptoms like short term memory loss and mood changes, before becoming more serious with things like tremors, slurred speech and dysphagia.

A lot of the symptoms that develop are similar to those of neurodegenerative disease like Parkinson’s and Alzheimer’s, which are often outcomes for those with CTE.

Dr Emer MacSweeney, CEO of Re:Cognition Health, explained how the company is working to overcome these diagnostic difficulties.

“The big thing at the minute is the impact of both single blows, but more importantly, the repetitive blows to the head that appear in contact sports,” she told NR Times.

“We’ve been working both on managing the clinical symptoms and looking at the types of symptoms that correlate, particularly with this condition that everyone is really concerned about.

“Up to this point, one of the big problems has actually been being able to diagnose it using objective biomarkers.

“One of the areas where we’ve really been pushing the boundaries is through the work to demonstrate evidence of CTE using very sophisticated forms of MRI sequences.

“This provides offline manipulation of data that will give us evidence of this type of structural brain injury, which is not visible using current conventional MRI.”

Over recent years Re:Cognition Health has worked with a number of professional rugby players to help learn more about CTE.

This mainly includes those who are retired as this is when symptoms usually start, but it has worked with players as young as in their 20s to get a full understanding of how the condition develops.

Its research is now being put into practice through the use of diffusion tensor imaging (DTI), which is providing this objective evidence for the condition.

This marks a major milestone in the treatment of the condition which has largely been unknown until recent years, having been named ‘punch drunk syndrome’ in the past due to its prevalence in former professional boxers.

“The most important thing is the fact that at the moment, CTE can only be diagnosed after people die,” Dr MacSweeney said. “What we’re working on is being able to make a diagnosis during life. 

“If you can make a diagnosis then you can implement a form of treatment management and you can also measure whether that treatment is being successful.

“But also, if you can identify what the problem is, then you can start to work at the front end and try to implement manoeuvres that will protect the brain from developing these problems in the first place. 

Now Re:Cognition Health is beginning to roll out studies to further its knowledge in this area.

This includes one piece of research which will monitor female rugby players who are competing on a national level.

In this they will be fitted with a protective headband which will monitor the impact each player’s brain receives, then using this data alongside Re:Cognition Health’s brain scans to have a detailed look at what damage repetitive head traumas are doing.

Researchers will be able to view each participant’s brain down to a microscopic level while also paying particular attention to what type of head impact is leading to the development of CTE.

Furthermore the study will look at what effect head impacts have on the blood-brain barrier and how this leads to the build up of abnormal proteins, one of the main known causes of dementia.

Re:Cognition Health is always looking at the other end of the spectrum and studying retired rugby players who are showing signs of developing these neurodegenerative conditions.

This will help the firm determine how effective current treatments are for these diseases.

However all of this is designed with the ultimate goal of coming up with a method of clinical diagnosis for conditions like dementia.

“For the retired players a diagnosis is essential,” Dr MacSweeney said. “If you know what’s wrong, then you’ve got a much better chance of doing the right thing to try to intervene in a way that’s meaningful and directed.

“For the younger players who are playing now, it’s incredibly important because what is most likely is that it’s not either one or two big concussions causing this.

“It is all these multiple small hits but not everyone is necessarily going to be as susceptible to developing these conditions as everybody else.

“What is most likely, is that there’s a threshold like in most things.

“There will be a certain amount of minor trauma to the head, which becomes cumulative and will reach a threshold point at which it’s going to be essential that a player should rest.

“Because this is such a big problem we want to give people the choice to understand what’s happening to their brain but secondly to allow them to continue to play in a much safer way.”

Re:Cognition Health brings together experts on all different types of brain conditions together to help its research.

The topic of neurodegenerative diseases in relation to sport has only started to hit the headlines in the last few years, but Dr MacSweeney says it isn’t a new issue.

“Has this suddenly become a problem or is it that we haven’t been noticing it? It’s a combination of two.

“The way the players, particularly those at higher levels, are training now is so different to what it was 15 years ago.

“Things like frequency they practice at and the actual weight of players has significantly increased, meaning the repetitive trauma that the players are being subjected to is much greater.

“Knowledge brings a problem like this to the surface but I don’t think anyone’s ulterior motive is to prevent the game, it’s to play safely.”

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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