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Brain injury

Young people ‘see brain disruption from multiple concussions’

Between three and five concussions affect the brain’s default mode network, new research has revealed

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Adolescents and young adults with post-concussive symptoms who have sustained three to five concussions show disruption in brain connectivity, a new study has revealed. 

The research, using resting state functional MRI (fMRI), shows the default mode network – an interconnected network of brain regions involved in wakeful rest and internal thoughts – is altered after a series of head injuries. 

In patients who had three to five concussions, the maps detected a disruption in the default mode network.

“We’re seeing evidence of a two-tier disease,” said Dr Thomas Johnson, a resident physician in neurology at the University of Rochester Medical Center in Rochester, New York. 

“Experiencing several concussions is a very different pathology.”

“Suffering three to five concussions has the potential for long-term disruption of cognitive processes. 

“We need to determine our tolerance for concussions. When do we say no more contact sports? We need more evidence to set some limits for people.”

The new study helps to shed new light on an age group in which the impact of concussion continues to be developed, said Dr Johnson. 

“In the last 20 years, the public awareness of concussion and its long-term effects on the brain has increased and so has research into the topic,” he said. 

“But there has been scant research using resting state fMRI at the intersection of the adolescent and young adult population and athletes with multiple concussions.”

The default mode network is a functional network of brain regions that becomes active when an individual is not involved in a specific mental task but is instead daydreaming, thinking about the future or recalling memories. 

Brain structures included in the network are the medial prefrontal cortex, posterior cingulate cortex, inferior parietal lobule, temporal cortex and hippocampal formation. 

Changes or disruptions in the network have been linked to a wide number of diseases and mental disorders.

“I think of the default mode network as the idle state of the brain, similar to an idling engine,” Dr Johnson said.

The study group included 142 concussion patients – 67 of whom are female, with a mean age of 18.2 years, and age- and sex-matched controls. The patients were enrolled in a concussion clinic at the University of Rochester Medical Center for post-concussion syndrome, which includes persistent symptoms such as headaches, dizziness, fatigue and irritability.

All patients and control group participants were scanned using resting-state fMRI while doing nothing but keeping their eyes open during the imaging process. The fMRI allowed researchers to evaluate the default mode network by identifying which areas of the brain activated during imaging.

“When certain areas of the brain get active, blood flow increases in those areas,” Dr. Johnson said. “Using a data analysis technique, we’re able to create a map for each individual in the study that shows how activity was distributed in space and over time.”

Compared to controls, the researchers found no difference in the connectivity in the default mode network in patients who had experienced one or two concussions. 

In patients who had three to five concussions, the maps detected a disruption in the default mode network.

In the future, Dr Johnson said he would like to conduct follow-up research on his study group by scanning the patients with resting-state fMRI in five years to determine whether disruptions in the default mode network remain.

“Trying to determine the cognitive impacts of concussion over the long-term is tricky to tease out,” Dr Johnson said. 

“Typically, we use standard paper tests. Using fMRI is an advanced mathematical way of looking at the networks in the brain.”

In the meantime, he said resting-state fMRI may be helpful as a marker of progress and means of monitoring recovery in patients with prolonged post-concussion syndrome.

“The current standard for evaluating concussive patients is based on symptoms,” Dr Johnson said. “I envision this technique being used to help inform and guide the clinical course of patients.”

Results are being presented next week at the annual meeting of the Radiological Society of North America (RSNA).

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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Brain injury

Calvert Reconnections delivering positive outcomes

Only months after opening, patients are already realising the benefits of the groundbreaking neurorehab centre

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Participants at ground-breaking neurorehabilitation centre Calvert Reconnections are already realising the benefits of the centre’s unique approach.

Calvert Reconnections opened its doors in June 2021, bringing a new, goal-focused, outcome-based approach to ABI rehabilitation.

Five months on, feedback from participants is now demonstrating how Calvert’s programme is delivering tangible results and pathways back to everyday life.

“Our programme is transforming the lives of our participants,” explained Claire Appleton, Head of Service at Calvert Reconnections.

“One of our recent residents said that his stay at Reconnections had transformed his quality of life, enabling him to return home, to his wife, rather than going into permanent 24-hour care.

“Such was the life-changing progress of another resident, he recently walked to the summit of Latrigg having only been able to walk a few hundred yards when he first came to stay with us.

“The whole team is hugely excited about the difference we are making to people’s lives.”

During meetings with other residents, Calvert Reconnections received the following feedback:

  • “I feel comfortable here, all the staff are really nice, they put up with me being confused or disagreeing, they are very patient.”
  • “You have made me realise you can get me closer to how I was before my accident. I accept who I am, I couldn’t do that before, I am OK with myself now.”
  • “I now have confidence to go about my ways.”
  • “You have improved my ability in lots of ways.”
  • “I cannot think of anything you could do differently or improve.”
  • The staff have a great can-do attitude.”
  • “I feel like I am getting better, getting fitter every day – my friends say I am getting better.”
  • “Doing different things all the time matters.”
  • “The specialist bike, the other people and the staff are all great.”
  • “I have a special bond with one of the participants – we love the banter.”
  • “It’s good to feel fitter again.”
  • “The staff are prepared to alter the programme with the weather and any other reasons.”
  • “It’s the people – we all keep an eye out for each other.”
  • “The food is great.”
  • “I have a lot of trust. I am asked to do things which seem difficult but it’s been possible, I’ve managed to be a metre or 2 off the ground on the climbing wall.”
  • “The cycling was good.”
  • “I am working on my dorsiflexion and this is brought in to my activities each day.”
  • “Reconnections has given me the opportunity to achieve my independence.”
  • “You asked me how we could improve Reconnections.  I have no criticisms – this is different to other rehab units, in a good way.”
  • “This is the best place for me to be.”

Calvert Reconnections has also recently announced its winter activity programme which includes walking and star gazing, bushcraft sessions, environmental art, photography projects, rock climbing (Calvert sports hall available), canoeing (Calvert swimming pool available), equine therapy, basketball (Calvert sports hall available), curling (Calvert sports hall available), badminton (Calvert sports hall available), sledging, cycling, ghyll scrambling and orienteering.

The centre has also been shortlisted for Best Initiative in Care at the Caring UK Awards.

Calvert Reconnections has places available now.  For further details, visit here

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