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Brain injury

TBI in UK Armed Forces to be investigated

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A new study is to investigate traumatic brain injury in armed forces personnel. 

The five-year project will look at the effects of TBI in battlefield casualties from the UK Armed Forces.

The TBI project aims to improve understanding of the relationship between environmental factors, such as TBI, and long-term neurological outcomes.

Participants for the TBI project will be recruited from the ADVANCE Study – the Armed Services Trauma Rehabilitation Outcome Study. 

ADVANCE is a 20-year longitudinal cohort study looking at the long-term physical and psycho-social outcomes of battlefield casualties from the UK Armed Forces following deployment to Afghanistan between 2002 and 2014.

The study has been running for several years and has already completed detailed baseline assessments of the 1,145 participants.

Professor David Sharp, centre director at the UK DRI Care Research & Technology Centre based at Imperial College London and the University of Surrey, has been awarded a five-year grant to investigate the new TBI study. 

The project is an extension to the ADVANCE Study and is funded by the ADVANCE Charity, with support from a grant from the Headley Court Charity. This new grant will allow Professor Sharp’s team to use state-of-the-art advanced neuroimaging, biomarkers and cognitive assessments longitudinally to assess how trauma relates to long-term brain health. 

The research team based at Imperial hope to build a better understanding of:

  • How common traumatic brain damage is within the ADVANCE cohort, and how it relates to the number and type of head injuries
  • Whether participants with TBI develop neurological or psychological problems over time
  • Whether early changes of dementia are detectable in the participants with evidence of previous TBI (using advanced brain scanning and blood test analysis)

Professor Sharp says: “We are excited to be leading this new ADVANCE TBI study and are grateful to the Headley Court Charity and the ADVANCE Charity for enabling this important work.

“We hope that the results will inform disease prevention in the future, in both military and civilian settings, as well as assist in the early diagnosis of neurodegenerative disease. 

“This, in turn, can facilitate prognostication and the development of disease-modifying treatments via clinical trials in high-risk groups.”

Participants in the TBI study will undergo assessments that include ultra-sensitive fluid biomarker analysis, advanced MRI (including DTI, fMRI, and 7T high field strength MRI), tau PET, and advanced computerised cognitive assessment. 

The study will largely take place at the state-of-the-art rehabilitation facility at Stanford Hall, where the core ADVANCE Study is already based.

Brain injury

High-res computer modelling to shed new light on TBI impact

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Researchers have created a traumatic brain injury (TBI) computer model that maps blood vessels in a rat brain in the highest resolution yet.

The team at Imperial College London say the models could help improve understanding of how blood vessels are affected by TBI, as well as its effects on the protective layer encasing them known as the blood-brain barrier (BBB), which protects the brain from harmful circulating molecules and pathogens.

If the methods translate well onto human brains, Imperial say they could also help improve understanding of how TBIs develop and how best to treat and protect against them.

The simulations could even help to replace animal models of TBI, potentially reducing the use of animals in brain research.

TBIs are the most common cause of chronic disability in under 40-year-olds and result from severe blows or jolts to the head. 

Beginning at the site of impact, mechanical forces travel in waves through the brain, twisting, stretching, and shearing brain structures as the injury cascades. These forces are known to affect blood vessels, but the finer details of the relationship between mechanical forces and vascular injury are yet to be established.

Now, researchers at Imperial have created a computer model of TBI which maps the network of vessels in the brain – called the vasculature – in the highest resolution yet, incorporating rat brain vessels just 10 microns in diameter.

Using the models, they found that adjacent blood vessels sustain profoundly different levels of stress depending on their alignment with neighbouring ones.

Blood vessels at 90 degree angles to others were less likely to be damaged, and vessels could be stretched to up to 14 per cent of their original length without injury, while stretching by more than this amount would result in injury.

Lead author Dr Siamak Khosroshahi, who conducted the work while at Imperial’s Dyson School of Design Engineering, says: “Our unique approach explains the unrecognised role of the vascular anatomy and shear stresses in how large forces cascade through the brain. This new understanding could contribute to improving TBI diagnosis and prevention.”

The degree to which the BBB lets molecules into the brain is known as permeability. The barrier can become more permeable after injury, making it more likely to let pro-inflammatory molecules reach the brain and usher in further injury.

By using rat models of TBI, the authors demonstrated that greater BBB permeability occurs in TBI as a result of disruption of the vasculature, and that this is most evident soon after injury.

From this information they created brain models digitally in high enough resolution to highlight the vasculature. They found that the computer models allowed them to accurately predict the distribution of stress in the small blood vessels of the rat brains. The models also allowed them to slow down time to look at the details of TBI more closely.

Senior author Dr Mazdak Ghajari, also of Imperial’s Dyson School of Design Engineering, says: “Injury happens in a fraction of a second, making it hard to observe exactly what goes on. By slowing down the process, we can pinpoint exactly which brain areas sustain the most damage and go some way to understanding why.”

The new, high resolution computer simulations could provide a blueprint for studying TBIs using more computers and fewer animal models, in line with the principles of Replacement, Reduction and Refinement (the 3Rs) in animal research.

The researchers say their models could also provide a more objective way to assess protection systems like helmets. Future studies on humans that include detailed reconstructions of the biomechanics of TBI are also needed to confirm the findings before using them to predict injury risk in humans.

The improved understanding of the BBB could also help further research into drug delivery of brain-specific medicines.

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Brain injury

Head injuries in rugby players linked to brain structure changes

A study of 44 rugby players, almost half of which had sustained a mild head injury while playing has revealed a significant proportion had signs of abnormalities to the white matter.

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A study of 44 rugby players, almost half of which had sustained a mild head injury while playing, has revealed a significant proportion had signs of white matter abnormalities.

It is the first study to assess long term changes in MRI images of professional rugby players. It also revealed abnormal changes in white matter volume over time.

The researchers say that more work is needed to determine the long term effects of rugby on player’s brain health.

The research is part of the Drake Rugby Biomarker Study. It was led by Imperial College London and published in the journal Brain Communications.

The research

The study took 44 players of which 21 were assessed after sustaining a mild head injury called a mild traumatic brain injury.

These are one of the most commonly reported match injuries accounting for one in five injuries. The rugby players were compared to other athletes in non-collusion sports and people who do not play sport.

Participants in the study underwent two MRI brain scans a year apart during 2017 and 2019.

The study used two advanced types of MRI called susceptibility weighted imaging and diffusion tensor imaging.

This reveals the structure of blood vessels and white matter. The white matter helps the brain cells to communicate with each other.

The players were also asked to complete memory tests to assess brain function.

Scientists analysed the brain scans for changes.

The scans revealed that 23 per cent of all the players showed abnormalities to their cell axons or small blood vessel tears. These tears cause small leaks in the brain called microbleeds.

The changes were seen in the players with and without a head injury.

Read more: Same You, a catalyst for change

rugby players in a scrum with their heads and shoulders down

Further research needed

Senior author from Imperial’s Department of Brain Science, Professor David Sharp said: “Despite relatively high rates of head injury and an increasing focus on prevention, there has been relatively little research investigating the long-term effects of rugby participation. More objective measures of the effects of sporting head injuries on the brain are needed to assist with the assessment and management of individual players.

“Our research using advanced magnetic resonance imaging suggests that professional rugby participation can be associated with structural changes in the brain that may be missed using conventional brain scans.  What is not clear at this stage is the long-term clinical impact of these changes.

“Further research is needed to understand the long-term implications of repeated head injuries experienced during a rugby career and to provide more accurate ways to assess risk for an individual.”

Clinical services

The research was funded by the Drake Foundation. A not-for-profit organisation focused on understanding and improving the health and welfare of people impacted by head injuries.

It was supported by National Institute for Health Imperial Biomedical Research Centre, the UK Dementia Research Institute and the Rugby Football Union (RFU).

Dr Simon Kemp, medical services director at the RFU, added that a specialist clinical service for the assessment and management of retired elite players will be provided. It aims to assess the brain health of players.

“We welcome any research that helps to advance our knowledge which is why we actively collaborated with the academic institutions on the Drake Foundation Rugby Biomarker Study from its inception, particularly to promote the recruitment of players.

“While it is unclear from that research what the individual long-term implications are regarding the brain changes seen in these advanced imaging techniques, it is clearly a priority to investigate this further.”

Read more: Seven devices that are revolutionising dementia care

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Brain injury

Community rehab programme saved by brain injury charity

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A vocational rehabilitation programme in the North East aimed at getting those living with a brain injury back into working life has been resurrected by a community charity.

Headway Tyneside worked closely with the NHS and fellow charities, Headway County Durham and Headway Darlington & District, to ensure the programme could continue following last year’s closure of Newcastle-based providers, Momentum Skills.

‘Headway to Work’ is the newly-branded service which will support around 14 people per year living in Durham and Darlington. Each participant will be individually assessed by therapists to gain an understanding of their difficulties, enabling the team to offer personalised support throughout the programme.

The training focuses on improving self-management skills such as self-care, goal setting, productivity, sleep and fatigue management, as well as technical skills such as IT and literacy. The final phase of the programme will involve voluntary placements for participants to ensure they feel comfortable, confident and have the relevant vocational skills before seeking paid employment.

In the future, the group hopes to deliver the ‘Headway to Work’ programme across more parts of the North East, within Gateshead, Newcastle, South and North Tyneside.

Alistair McDonald, chairman at Headway Tyneside, explains: “We all know how incredibly difficult the past 18 months have been. Those with disabilities or long-term health conditions have been especially vulnerable. The Momentum programme was well received and helped lots of individuals with a brain injury plan a route into employment, education or training and it’s fantastic that we can continue to deliver this type of service.

“The service will now be delivered closer to where participants live rather than having to travel to Tyneside. Less travel and being in a more familiar place should help people feel less fatigued and provide an opportunity to socialise and development friendships with other learners local to them.

“Currently, we have around 10 staff, including Julie Meighan our clinical service development manager, who will oversee training sessions run by a neuropsychologist and job coach. Julie worked as a specialist brain injury occupational therapist for many years so has the clinical knowledge and experience this programme needs.

“Our fantastic team of committed volunteers will support the delivery of this vital work to those who want to prepare for a return to work or plan a route into employment, training or education.”

Headway Tyneside is an independent charity providing support services to brain injury survivors and their families. In recent years, the board of trustees has developed a strategy to grow the scale and scope of services to provide more diverse and specialist services to their members.

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