By James Murphy

The UK’s first Sports Concussion Research Symposium started with a warm welcome by Velicia Bachtiar (Drake Foundation¹) and Dr Simon Kemp (Rugby Football Union (RFU)). Dr Charlotte Cowie (Football Association (FA)) then kicked off official proceedings. This day brought together the concussion and traumatic brain injury communities that in the past have been disconnected. It called for collaboration – a key concept of the day!

Session 1 – Current UK Sports Concussion Research Landscape

Challenges to Concussion Research (Dr Charlotte Cowie and Professor Keith Stokes)

Factors that hamper research:

• concussion not a current priority within the sport of your research area
• funding issues may restrict the size of studies or prevent them from starting in the first place.

Opportunities

Dr Simon Kemp brightly opened by confirming that for the RFU, concussion is the number one medical priority. He confirmed that across sports it is now widely recognised that governing bodies and clubs have a duty to consider the long term health of those playing their game.

To make significant advances in the field, larger projects need to take place, but you:

• can still ‘do your own thing’
• should have some commonality with other studies
• should use common data elements (for comparison and metanalysis purposes).

Opportunities (Academia) – Prof David Menon

We need to ensure we are all talking about the same thing before we start comparing our results. To this end he defined TBI as: “an alteration in brain function, or other evidence of brain pathology, caused by an external force”. (2)

Session 2 – Snapshots of UK Sports Concussion research in progress

In this session researchers presented methodology and some preliminary results from their work.

Results of RECOS programme (Professor Tony Belli, University of Birmingham)

• Changes in some specific mRNAs may also allow prediction of symptom severity and clinical course.

Football heading produces immediate changes in brain function (Dr Magdalena Letswaart, University of Sterling)

• Repeated heading of a football affected patient’s cognition and memory over the following 24 hour period – although further work required! (3)

Developing biomarkers for concussion (Dr Etienne Laverse, University College London)

• Previous research has shown that Neurofibrillation light chain is a marker of subconcussive head injuries – further research planned in rugby players!

Neuroimaging for the evaluation of traumatic brain injury (Professor David Sharp, Imperial College London)

• David Sharp showed how MRI techniques can show evidence of axonal injury after concussion
• Do changes in biomarkers precede clinical symptoms?

Investigating the effects of concussion on schoolboy rugby union players: a pilot study of epidemiology and rehabilitation (Dr Éanna Falvey, Sports Surgery Clinic, Dublin)

• Is exercise below the level at which patients are symptomatic beneficial in their rehabilitation from a concussive injury. This research leads on from studies in America by JJ Leddy et al (4).

The International Concussion and Head Injury Foundation Study LINK (Dr Michael Turner, ICHIRF)

• This study will compare the incidence and age of onset of depression, suicide and neurodegenerative disorders in retired jockeys versus aged matched controls.

Safer systems for return to play decisions: the promise of integrating neurocognitive testing and neuroimaging (Professor Huw Williams, Univeristy of Exeter)

• This work by Professor Huw Williams aimed to ensure a safer return to play for athletes. His work is currently looking at the neuroimaging and neurocognitive tests of concussed elite and university rugby players.

Brain health and healthy AgeINg in retired rugby players: The BRAIN study (Valentina Gallo, Queen Mary University London and Professor Neil Pearce, London School of Hygiene and Tropical Medicine)

• The researchers will compare physical and cognitive capabilities, biomarkers and intermediate neurological endpoints to determine if there are any long term health risks associated with playing rugby.

Session 3 – Breakout

In the middle of the afternoon the delegates split off into groups and discussed many of the key topics in this area: concussion diagnosis, management, surveillance and long term health impacts to name a few. Group facilitators reported back on each group’s discussion.

What were the talking points?

• A concussion definition could focus on symptoms and signs of the injury as this is what is used in its diagnosis- this should include a reference to traumatic brain injury.
• For effective concussion surveillance standardised definitions of concussion and methods of diagnosis should be used – we can achieve this through collaboration.
• We do not yet know the effect of head impacts on long term health.
• Any head impact could be subconcussive, more work is needed here.
• Do the physical, cognitive and social benefits of participating in sport outweigh the neurocognitive risk? It is up to each individual to decide and for healthcare professionals to inform players as best as they can.

Symposium summary

Professor Mark Batt closed the day with a summary of key points. His call to action was for research groups to pull together and collaborate! Is it possible to create vast research networks such as ARUK’s Centre for Sport, Exercise and OA, focused purely on concussion? (5) He underlined the amount of funding there is for concussion research in America, and that researchers need access to similar sums in the UK.

A great day, if you have any of the answers to the questions above, feel free to pen a blog on them, and get in touch with those currently undertaking this important research!

References

The Drake Foundation – ‘About us’ – Accessed 24/11/16 https://www.drakefoundation.org/about-us/

Position statement: definition of traumatic brain injury. Menon DK, Schwab K, Wright DW, Maas AI Arch Phys Med Rehabil 2010;91: 1637-40. https://www.ncbi.nlm.nih.gov/pubmed/21044706

Thomas G. Di Virgilio, Angus Hunter, Lindsay Wilson, William Stewart, Stuart Goodall, Glyn Howatson, David I. Donaldson, Magdalena Ietswaart, Evidence for Acute Electrophysiological and Cognitive Changes Following Routine Soccer Heading, EBioMedicine, Volume 13, November 2016, Pages 66-71, ISSN 2352-3964, http://dx.doi.org/10.1016/j.ebiom.2016.10.029.http://www.sciencedirect.com/science/article/pii/S235239641630490X

John J. Leddy, John G. Baker, Barry Willer, Active Rehabilitation of Concussion and Post-concussion Syndrome, Physical Medicine and Rehabilitation Clinics of North America, Volume 27, Issue 2, May 2016, Pages 437-454, ISSN 1047-9651, http://dx.doi.org/10.1016/j.pmr.2015.12.003.

http://www.sportsarthritisresearchuk.org

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James Murphy has completed four years of medicine at Newcastle University and is currently intercalating on the MSc Sports and Exercise Medicine course at the University of Nottingham.