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Brain injury

Scans ‘can detect brain injury sustained through sport’

The consequences of multiple head impacts can be detected by MRI during an athlete’s lifetime, a new study has found

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Scans can detect brain injury sustained through repeated head impacts in sport, a new study has found. 

Research has found that brain scans taking during the lifetimes of athletes in contact sports, compared to changes in their brains at autopsy, showed that white matter hyperintensities were associated with neuropathological changes.

The study also found that white matter hyperintensities – seen as markers of injury – were more common in athletes who played contact sports longer or had more head impacts during their careers.

White matter hyperintensities are areas that appear bright on magnetic resonance imaging (MRI) scans. They are common in people as they age and with medical conditions like high blood pressure.

“Our results are exciting because they show that white matter hyperintensities might capture long-term harm to the brain in people who have a history of repetitive head impacts,” said study author Dr Michael Alosco, of the Boston University School of Medicine. 

“White matter hyperintensities on MRI may indeed be an effective tool to study the effects of repetitive head impacts on the brain’s white matter while the athlete is still alive.”

The study involved 75 people who were exposed to repetitive head impacts and had reported symptoms. 

This included 67 American Football players and eight other athletes in contact sports like soccer and boxing, or military veterans. Of the football players, each of whom played an average of 12 years, 16 athletes played professionally and 11 played semi-professionally.

All donated their brains to research after their death in order to advance research into the long-term effects of repetitive head impacts. 

Researchers then looked at medical records, including scans which were done while the athletes were still alive. Participants had scans taken of their brains, on average, at age 62. The average age of the athletes at death was 67.

Of the participants, 64 per cent were judged to have had dementia prior to death. This was determined by a discussion with their loved ones. 

Autopsies showed that 53 people, or 71 per cent, had chronic traumatic encephalopathy (CTE). CTE is a neurodegenerative disease associated with repetitive head impacts, including those from football, that can progress to dementia.

After examining the brain scans, researchers found that for every unit difference in white matter hyperintensity volume, there was about twice the odds of having more severe small vessel disease and other indicators of white matter damage, as well as three times the odds of having more severe tau accumulation in the frontal lobe of the brain. 

Tau protein accumulation in the brain is a biomarker for progressive brain diseases like Alzheimer’s disease and CTE. 

Researchers also found that higher amounts of white matter hyperintensities were associated with more years of playing football.

When it came to completing daily tasks, greater amounts of white matter hyperintensities were associated with higher scores on a questionnaire about performing daily tasks that was completed by caregivers of the brain donors.

“There are key limitations to the study, and we need more research to determine the unique risk factors and causes of these brain lesions in people with a history of repetitive head impacts,” Dr Alosco added.

Brain injury

Expert panel to assess future of brain injury rehab

The webinar on Wednesday will examine the challenges and opportunities in neurorehab now and into the future

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Experts from across the world of brain injury rehab are coming together to assess the future of the sector at an event this week. 

The webinar – What does the future of brain injury rehabilitation look like? – brings together leaders in their field of assess what challenges and opportunities lie ahead. 

Scores of people have already signed up for the hour-long live online event, on Wednesday at 4.30pm, with places still available and questions can be submitted in advance. 

The expert panel comprises:

The event marks the second webinar held by NRC Medical Experts, in association with NR Times, following a successful debate about the Rehabilitation Prescription earlier in the year. 

The upcoming webinar will focus on brain injury rehab, and the advances made in innovation to better meet the needs of people living with life-changing injuries. 

Through changes in technology, developments in medicine and the advances in neurorehabilitation, brain injury patients should face an outlook which is better than ever before. 

However, the lack of resource within health services, exacerbated by the ongoing impact of COVID-19 and mounting pressures on the NHS, mean that progress and change is not being seen at the rate many would hope for. 

“We are very much looking forward to addressing the very pertinent topic of brain injury rehabilitation with our stellar panel, all of whom have a vital role to play in supporting people living with brain injuries and their families,” says Deborah Johnson, editor of NR Times. 

“Innovation and technology is a hugely exciting area, but the impact of COVID on already stretched resources is of great concern. 

“Our webinar will look at the challenges and opportunities that lie ahead, and what more can be done to improve the lives of patients and their families.”

To attend the webinar, registration is required in advance. To sign up, visit here 

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Brain injury

ABI strategy confirmed by Government

Huge breakthrough in support for people with brain injuries comes after Chris Bryant MP introduced the ABI Bill

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The Government has today committed to producing a strategy to deliver better support to people living with acquired brain injury (ABI), following efforts from MP Chris Bryant and an array of charities and leading figures to force them into action. 

In a statement, it was confirmed a strategy will be drafted with a call for evidence being launched early in the new year to help shape its development. 

Gillian Keegan MP, Minister for Care and Mental Health, said the development of the strategy would be co-chaired by herself and Mr Bryant, with senior officials in all relevant Government departments invited to join the board. 

“Following publication, the strategy will be kept under review and may be revised periodically to ensure that it continues to reflect the priority areas and actions needed to best support people living with ABI and their families,” the statement said. 

The move by the Government marks a huge step forward in ABI provision, following years of campaigning from charities and survivors for more support. Mr Bryant recently introduced a Private Members Bill with the aim of forcing the creation of such a strategy, which was due to have its second reading in Parliament tomorrow. 

Mr Bryant – chair of the All Party Parliamentary Group (APPG) on ABI and a tireless campaigner for the cause – had called on the Government to take action to ensure a more joined up approach from Government departments in supporting individuals and families affected by brain injury. 

Last month, he delivered a letter signed by over 200 MPs, charities, brain injury survivors and other providers to 10 Downing Street, calling on the Prime Minister to take action. Following that, Boris Johnson confirmed in Parliament that the Department for Health and Social Care would be looking at the development of such a strategy. 

It has also been supported widely by the public and via social media.

But today’s confirmation is a huge step forward and will ensure the development of an appropriate strategy, with input from families and professionals across the world of ABI. 

Announcing the development on Twitter, Mr Bryant said: “ The Government has just announced it will draft a strategy on Acquired Brain Injury, set up an ABI programme board which will be co-chaired by Gillian Keegan and me, and will call for evidence very soon. 

“So my ABI Bill won’t be needed. Many thanks to all who’ve helped!”

Charities who have been vocal in their support of Mr Bryant’s Bill were keen to celebrate the move, which comes after years of campaigning. 

UKABIF hailed the announcement as “a gift” and the Disabilities Trust said it was “just amazing”. 

The Child Brain Injury Trust added: “Fantastic news to hear. A strategy for ABI has been needed for so long. We are thrilled!”

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Brain injury

UEFA concussion charter urges protection and education

The importance of educating players, coaches, referees, doctors and the public about dangers of concussion in football is highlighted

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A European-wide football concussion charter has been launched, stepping up efforts to safeguard players and urging the education of those involved in the game around the dangers of impacts to the head. 

UEFA has launched its concussion charter, which will apply to all teams taking part in men’s and women’s club and national team competitions across Europe. 

The charter aims to reinforce the importance of good practice in concussion management and highlights the concussion procedures that should be followed. 

It also promotes the education of players, coaches and staff about the concussion procedures in force at UEFA games. Team doctors are being asked to organise specific education sessions to brief players, coaches and staff about the concussion procedure to be followed at UEFA matches.

Furthermore, its 55 member associations are ‘strongly encouraged’ to deploy where possible, a medical video review system at their stadiums to enable immediate and informed injury assessments.

UEFA will facilitate the installation of the system with the host broadcaster. Home teams using a medical review system should offer the visiting team the same system.

Club and national teams are being urged to sign the charter to underline their commitment to safeguarding the health of their players.

In doing so, the signatories pledge their full support for UEFA’s guidance on how to recognise and manage a head injury from the time of injury through to the safe return to football.

“Everyone should know how to react and what to do,” said Tim Meyer, UEFA Medical Committee chairman. 

“Concussion is undoubtedly a serious injury which needs to be managed and treated properly. 

“The health and safety of any players taking part in Europe’s club and national team competitions is of paramount importance not only to UEFA, but also to national associations across the continent.

“Although research studies report a low incidence in football, everyone should know how to react and what to do in the event of a concussion on the pitch.

“By signing this charter, clubs and national teams will demonstrate their support for UEFA’s concussion awareness activities – and take a considerable step forward in helping to protect their players.”

The measure is the latest stage in efforts to safeguard players, following steps including UEFA’s implementation of a keynote concussion awareness campaign in 2019 and the Premier League becoming the first competitive league in the world to introduce concussion substitutes. 

UEFA’s head injury procedure is:

• In the event of a suspected concussion, the referee will stop the game to allow the injured player to be assessed by the team doctor. Players should remain calm during the situation and not interfere with the assessment.

• The assessment should in principle not take more than three minutes, unless a serious incident requires the player to be treated on the field of play or immobilised on the field for immediate transfer to hospital.

• If the assessment cannot be made after the three minutes and/or a suspicion for a concussion arises, the player should not be allowed to continue playing.

• A player suffering a head injury that requires assessment for a potential concussion will only be allowed to continue playing after the assessment, on specific confirmation by the team doctor to the referee of the players fitness to do so.

The decision remains entirely with the team doctor. Coaches, referees and players are not allowed to interfere in the assessment and decision of the doctor.

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