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Rugby facing lawsuit over neurodegenerative diseases

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Experts say there is an 'epidemic' of players who will suffer from neurological diseases

Eight former professional rugby players are planning a groundbreaking lawsuit against the sport’s governing bodies which could massively shake up its safety regulations.

Despite being under the age of 45, all the players involved have been diagnosed with early onset dementia, which is likely to have come from repeated head trauma while playing the sport.

The lawsuit will be filed against the sports worldwide governing body World Rugby, as well as the Rugby Football Union and the Welsh Rugby Union.

Solicitor Richard Boardman of Rylands Law is leading the case, representing more than 100 former players who have complained about symptoms of neurological conditions.

“The vast majority of the former players we represent love the game and don’t want to see it harmed in any way,” Boardman said. “They just want to make it safer so current and future generations don’t end up like them.”

He also said there is a ‘ticking time bomb’ of players waiting to come forward with similar conditions once they retire.

Rugby is not the only sport to be in the news recently regarding head trauma, with calls for football to change its ways around concussion to better protect players.

Memory loss is one of the main symptoms that the players are recording, with ex-England hooker Steve Thompson saying he can’t remember winning the 2003 World Cup.

Former Wales international Alix Popman was also involved in a fire in his own home due to not remembering that he left the grill on.

Popman was diagnosed with dementia earlier this year aged 40, with his doctor saying he could be in a care home by the time he is 50.

Speaking to the BBC, he said: “there were areas on my brain that were picked up on the scan that showed significant damage. I think they worked out I have had over 100,000 sub concussions during my career.

“The neurologist described it as a leaking tap. So, a leaking tap on a piece of mud if it drips once or twice, there would be no mark on the floor.

“But if it dripped for 14 years, there would be a big hole and that is the damage that is showing on the scans for myself.”

Popman’s wife, Mel, says she has already noticed changes in her husband’s behavior, telling the BBC “it’s watching the lights fading gradually in him and watching those changes. Him being here but not being the same Alix.”

A statement from Rylands Law said the sports governing bodies “owed the players, as individual professional players, a duty to take reasonable care for their safety by establishing and implementing rules in respect of the assessment, diagnosis and treatment of actual or suspected concussive and sub-concussive injuries”

Boardman continued this, saying: “We are now in a position where we believe the governing bodies across the rugby world are liable for failing to adequately protect their players on this particular issue.

“Depending on how many people come forward, the case could be worth tens of millions, maybe even hundreds of millions. Right now we’re representing over 100 former players but we expect many more to get in contact. In short, it is an epidemic.”

The group of players have also set out 15 safety regulations, which includes introducing tests for concussed players, regulated training and more education on neurodegenerative diseases.

In a response to BBC Sport, World Rugby said: “While not commenting on speculation, World Rugby takes player safety very seriously and implements injury-prevention strategies based on the latest available knowledge, research and evidence.”

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Landmark breakthrough in understanding Alzheimer’s

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Brain cells vulnerable to Alzheimer’s Disease have been identified for the first time, in a breakthrough scientists hope could lead to targeted treatments to boost the brain’s resilience.

It has so far remained unknown in Alzheimer’s research why some brain cells succumb to the disease years before symptoms first appear, while others seem unaffected by the degeneration surrounding them until the disease’s final stages.

Now, in a groundbreaking study, the neurons that are among the first victims of the disease –  accumulating toxic ‘tangles’ and dying off earlier than neighbouring cells – have been identified for the first time.

“We know which neurons are first to die in other neurodegenerative diseases like Parkinson’s disease and ALS, but not Alzheimer’s,” says co-senior author Martin Kampmann, associate professor in the UCSF Institute for Neurodegenerative Diseases.

“If we understood why these neurons are so vulnerable, maybe we could identify interventions that could make them, and the brain as a whole, more resilient to the disease.”

Alzheimer’s researchers have long studied why certain cells are more prone to producing the toxic tangles of the protein known as tau, whose spread through the brain drives widespread cell death and resulting progressive memory loss, dementia, and other symptoms.

But researchers have not looked closely at whether all cells are equally vulnerable to the toxic effects of these protein accumulations.

“The belief in the field has been that once these trash proteins are there, it’s always ‘game over’ for the cell, but our lab has been finding that that is not the case,” said Lea Grinberg, senior co-author and associate professor in the UCSF Memory and Ageing Centre.

“Some cells end up with high levels of tau tangles well into the progression of the disease, but for some reason don’t die.

“It has become a pressing question for us to understand the specific factors that make some cells selectively vulnerable to Alzheimer’s pathology, while other cells appear able to resist it for years, if not decades.”

To identify selectively vulnerable neurons, the researchers studied brain tissue from people who had died at different stages of Alzheimer’s disease, obtained from the UCSF Neurodegenerative Disease Brain Bank and the Brazilian BioBank for Ageing Studies.

The São Paulo-based biobank collects tissue samples from a broad population of deceased individuals, including many without a neurological diagnosis whose brains nevertheless show signs of very early-stage neurodegenerative disease, which is otherwise very difficult to study in humans.

The team studied tissue from ten donor brains using a technique called single-nucleus RNA sequencing, which let them group neurons based on patterns of gene activity.

In a brain region called the entorhinal cortex, one of the first areas attacked by Alzheimer’s, the researchers identified a particular subset of neurons that began to disappear very early on in the disease.

Later in the course of the disease, the researchers found, a similar group of neurons were also first to die off when degeneration reached the brain’s superior frontal gyrus.

“These findings support the view that tau buildup is a critical driver of neurodegeneration, but we also know from other data from the that not every cell that builds up these aggregates is equally susceptible,” adds researcher Kun Leng.

“Our discovery of a molecular identifier for these selectively vulnerable cells gives us the opportunity to study in detail exactly why they succumb to tau pathology, and what could be done to make them more resilient.

“This would be a totally new and much more targeted approach to developing therapies to slow or prevent the spread of Alzheimer’s disease.”

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Patients enabled to take control of recovery through new programmes

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Two new Recovery Facilitation Programmes (RFP) designed to empower people to take greater control of their recovery and enable them to better manage their conditions have been launched.

Energise Health’s six-week programmes, Energise Recovery and Energise Recovery 4Life, equip both recently-diagnosed people and those living with long-term conditions with the knowledge and skills they need to make beneficial and lasting changes.

Energise Recovery – for those at an early stage of recovery – and Energise Recovery 4Life – for those at least six months into their recovery journey – are online programmes that offer live teaching sessions on a range of topics, alongside practical activities and guided coursework.

Energise Health has been created by Nurse Pain Specialist Dr Dee Burrows and Occupational Therapist Victoria Collins, who brought together years of expertise to develop these programmes, which they have seen, from their own experiences, are badly needed.

“The concept came from a really challenging case we were both working on, where we realised that had this particular client been given access to something like this at an early stage in their recovery, it would have prevented so many secondary complications,” says Victoria.

The programmes – devised over 18 months, in consultation with experts in the field – aim to educate participants in how to tackle and improve issues around pain, stress, depression, poor sleep and lack of confidence in daily activity. Participants are shown how to adopt a bespoke range of strategies that they can incorporate into their daily lives to help them manage.

Although the business launched during the COVID-19 pandemic, unlike many initiatives that were taken online out of necessity, Energise Recovery and Energise Recovery 4Life were intentionally developed as online programmes.

“We designed this to be online as we wanted a facilitated group-based programme,” says Dee.

“And when you are supporting people who are living with injuries or conditions, their recovery is best facilitated if they have the energy to spend on it, rather than exhausting themselves through travel. It is also a more environmentally friendly model, which is important to both of us.

“We can have people from across the country, whether Edinburgh, Leeds, or Cornwall coming together in a way that will benefit them individually and collectively. We look forward to sharing it with more people.”

Energise Recovery and Energise Recovery 4Life introduce participants to a range of strategies from mindfulness to Tai Chi, belly breathing to sleep management, diet to exercise and connecting with others, all backed by a comprehensive handbook and activity diary.

“We are enabling people to try a range of different strategies – all of which have been carefully chosen for this purpose, determine which ones they want to pursue and learn how to integrate them into their daily routine,” says Victoria.

“We enable them to develop a personalised toolkit, with strategies to manage their conditions.  Participants can develop their own script. We are empowering them to find out what works for them.”

In the six-month pilot of both programmes, engagement levels were 100 per cent in terms of both session attendance and self-reporting, with ongoing success seen in terms of individual outcomes. On average, participants started their programme with 3.75 self-management strategies, rising to 26.25 at programme completion.

“What we do is based on the principles of hope, engagement, support and self-management, and the desire to change is something we look for when accepting participants,” says Dee.

Victoria says: “The programmes are a foundation. We provide high quality resources and links for people to learn more and develop if they wish, and, through our teaching, explain key components and how they might be applied. It is bitesize and digestible.

“We are enabling people to enhance their ability to self-manage. By adopting the strategies into their lives, we have already seen how this can give individuals hope for the future and be of great benefit to their mental, social and physical wellbeing.”

Dee adds: “While the early stage Energise Recovery Programme will always give the best possible chance of recovery, Energise Recovery 4Life can be equally beneficial for those with long-term conditions, including, for instance, Long Covid

“We have noticed that some participants do better with their clinical interventions when they have completed the Programme as a foundation and have a toolkit of strategies in place. It can also, however, work well in tandem with, or after clinical interventions.”

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Concussion substitutions approved in football – but move ‘doesn’t go far enough’

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Charity Headway argue that the move still does not go far enough

Years of campaigning for concussion substitutions to be introduced into football look set to deliver some success, with Premier League clubs preparing to adopt the policy to help address the need to protect players from the effects of head injury.

In a trial move, expected to take effect from fixtures next week, teams can use up to two substitutes in the event of head injuries, which will be in addition to the usual three substitutions that can be made in a normal match.

The substitutions – which will be permanent and not for 10-minute durations as in rugby, to allow for players to leave the pitch for medical assessment and return if deemed able – are expected to be approved at a meeting of the Premier League tomorrow.

Pressure has been mounting on football to address the issue of players suffering concussion and head injuries during matches, with on-pitch medics having to make decisions in three minutes on a player’s ability to continue, returning him to the pitch, or else removing him from the match completely.

The Premier League will become the first league to adopt concussion substitutes, and the finer details are currently being agreed with FIFA ahead of their expected introduction in a matter of days.

However, brain injury charity Headway argue that the move still does not go far enough in awarding protection to players, and argued permanent substitutions are not the way forward.

“We’ve been pushing for many years to bring football up to date with other sports in terms of concussion substitutes, but this plan involves permanent substitutes rather than concussion substitutes,” deputy chief executive Luke Griggs tells NR Times.

“So in that sense, it’s a bit disappointing.

“The FA chief executive said in December they needed to explain why permanent substitutes are better than temporary substitutes in this situation, but that has not happened.”

While it is a step forward that players are being protected, say Headway, the 10-minute alternative that works in sports like rugby has much greater benefits.

“In sounds great that football are introducing this measure which has been needed for a long time, but in practice, the medical assessment of the player is still going to have to be made in that three minute window on the pitch, rather than in the quiet confines of the dressing room if you had ten minutes,” says Luke.

“You also need a degree of honesty from the players in being able to assess them properly, and for them to say they feel nauseous and have blurred vision after a collision. If they know they are going to be taken off for the whole match, rather than the potential to return after ten minutes, then they might not want to be so honest.

“Of course we realise that even in ten minutes some symptoms may not present themselves, and it could be 24 hours later or maybe longer, ten minutes off the pitch to make an assessment is an awful lot better than three minutes on it.”

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