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“Children need exercise, not hits to the head”

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Having played an instrumental role in initiating changes to player safety in NFL, Dr Chris Nowinski speaks to Deborah Johnson about the urgency to ensure that is replicated elsewhere in the world.

Having experienced concussion during his career as a high-profile WWE wrestler, and been left shocked by the lack of awareness of the issue at all levels of sport, Dr Chris Nowinski is now leading the charge for change for head injury in sport around the world.

Since 2007, Dr Nowinski has pushed the boundaries of what had become accepted as ‘the norm’ in sport – that there was ‘glory’ in players getting up and carrying on despite head injury; that there was no accepted correlation between multiple head impacts and longer- term neurological consequences; that sport was not taking more responsibility in protecting its players – and is helping to redefine the life-changing issue of player safety.

And through the efforts of Dr Nowinski and his Concussion Legacy Foundation, significant change has taken effect in the United States, particularly in the National Football League (NFL), which was “embarrassed into action” through his 2006 book Head Games: Football’s Concussion Crisis.

The book, which also became a documentary, examined the long-term effects of head trauma among athletes, and was described by The Lancet as having “sent shockwaves through NFL”.

The Foundation was also instrumental in the creation of the world’s first Brain Bank dedicated to the study of Chronic Traumatic Encephalopathy (CTE), which has led to the long-held understanding of brain trauma being revolutionised.

Through its pioneering research, the VA-BU-CLF Brain Bank remains the most significant CTE resource in the world, which has discovered the first cases of CTE in athletes whose primary exposure was soccer, rugby, baseball, ice hockey, and college and high school football.

“In the US our understanding of concussion has changed completely. When I was injured, they were still putting people who had been knocked unconscious back into the game, saying they’re fine,” Dr Nowinski tells NR Times.

“Through advocacy, we started to change the discussion and show how unethical it was to put someone back into the game. We focused on NFL because if we get them to change, then everyone would change.

“There are now laws in every state which mean medical clearance must be given to players with concussion allowing them to return, we now tend to talk about concussion in the right way – in European soccer we see players being knocked unconscious, like we did in the recent UEFA tournament, but that doesn’t happen in the US anymore without a massive outcry.”

And while such an ‘outcry’ has not been widespread in sport elsewhere in the world until more recently, happily change is starting to take effect, with the UK now seeing action like never before.

Both football and rugby governing bodies are introducing new protocols, spurred into action by the many former players who have revealed devastating diagnoses of neurodegenerative illness.

Dr Nowinski and his team have worked closely with the Astle family, who are campaigning for change in memory of footballer Jeff Astle, whose memory continues through the Jeff Astle Foundation which is dedicated to raising awareness of brain injury in all sports and offers support to those affected.

The willingness of the many sports professionals and families who have played their part in lifting the lid on the reality of brain injury in sport is crucial in bringing about change in sport, even where there may be resistance, says Dr Nowinski.

“I am amazed at the courage of families who are saying their loved one has dementia, without the steady drum beat of such stories this could be swept under the carpet again,” says Dr Nowinski, a Harvard graduate who later gained a PhD in neuroscience.

“People think this problem doesn’t exist because we don’t see it, but families previously chose to keep it private as nothing positive had ever happened before through going public.

“If we continue to push the rock up the hill and continue to fight for change, it will happen. To change a culture, you have to know the culture.

“I don’t recall any recent players being knocked unconscious and being put back in saying ‘I shouldn’t have been put back in the game’ and that needs to happen – but there is bad leadership within the football community and players feel without protection.

“There are a lot of studies in the US linking head impacts to brain disease which are well-known, but people outside the US tend to ignore them. There is always a scientist who will say they’re not sure about the findings, or we don’t know if the changes we’re seeing are permanent.

“In the US, there are some very outspoken doctors who represent professional sports leagues and they focus on minor criticisms to justify inaction, rather than the clear solution of preventing the hits to head that cause brain injury.

“While these doctors do their best to have their patients’ best interests in mind, even the most ethical doctors will be influenced by their professional position, this can lead to tremendous conflicts of interest.

“I’ve had threatening letters from UK football teams. In the US, it took journalists outside of sport to be willing to offend, and very powerful newspapers who don’t care if their reporters have been threatened to lose access to the teams they cover.

“Professional sports leagues are incentivised to minimise the the risks of concussions and CTE as they pose risks to profits, and that has unfortunately also played out in the UK.”

While the recent findings of the Parliamentary inquiry into brain injury in sport – where it was noted that governing bodies are effectively ‘marking their own homework’ – are encouraging, says Dr Nowinski, action must be taken and lessons learned.

“The Government has a huge role to play and the most recent hearings are a good start,” he says.

“In 2009, things started to change in the US when the NFL were embarrassed into taking action through public Congressional hearings, and we realised if we continue in this direction, we can help to get the change we need.

“One of the important things we did was to explore how the NFL’s Mild TBI Committee was doing terrible research and we got that committee to be retired.

“This issue needs to be looked at independently – it’s a public health issue and we are still only scratching the surface.

“This isn’t just an issue of dementia, where people lose a few years off the end of their lives but they got to be a hero as a sports player – we’re not recognising the danger of this disease to people in early- and midlife, and that limits motivation for people to change.”

A vital place to start is in protecting players from the very start of their experience of sport – from childhood.

The Concussion Legacy Foundation adopts a stance in the US of encouraging parents not to expose their children to tackle football or any repetitive brain trauma, including heading in soccer, until the age of 14.

“We need to stop hitting children in the head,” says Dr Nowinski.

“We have young children playing sport by the same rules as adults and that’s insane. We should be focused on what is best for children, they need exercise, not hits to the head.

“The odds of developing CTE are associated with how many years someone has been playing, and the correlation is extraordinary. We find it in boxing, we find it in American football, and we’re going to find it with soccer and rugby.

“If we want to eliminate CTE in sports, then we need to reduce the number of years when they’re experiencing repeated head impacts as children. It is not the time when they’re an adult and they’re being paid to play.

“If we reduce exposure among children, we can make it less likely they will get CTE. Right now, we assume we will only get better at dangerous activities by practicing those activities. That model, though well intended, is a mistake.

“The faster we act, and it’s very urgent we do that, the less we will see what is happening today in the next generation of sports people.”

Another important area is how concussion is portrayed in the forum where most people consume sport – via the media.

The creation of the Concussion Legacy Foundation’s Media Project has helped to change the language used around head injury in sport, and in turn the perception of millions of viewers, particularly among the younger generation.

“We have established the CLF Media Project in the US, which we’re now working on in the UK, we’ve done some work with professional journalists as well as students at university,” says Dr Nowinski.

“It’s very hard to reach a lot of people on this issue, and their understanding of concussion comes from watching sport on TV.

“This is an important moment in time. A few years back, the US media were still glorifying players playing through concussion, they weren’t using the word ‘concussion’ and broadcasters were pretending nothing was happening.

“We wanted to help them with the terminology that can describe what is happening without being seen to diagnose anything. In the UK and Europe, we see players playing through concussion, like in the recent UEFA tournament, and we don’t want these poor examples to parents and coaches to manifest into poor concussion care for children because the inappropriate medical care isn’t being criticised.

“There can be a backlash against commentators because television is a business like football, but we hope to give broadcasters the tools they need to cover concussion right.”

But underpinning the change is the research, which continues to be fundamental in greater understanding of, and action around, brain injury in sport.

Following the huge advances effected by the creation of the VA-BU-CLF Brain Bank, collaborations have since followed with the University of Sydney, which has collected 30 donated brains in the past three years, and the University of Auckland has just received its first donation.

And the pioneering impact is now coming to the UK with the creation of the Concussion Legacy Foundation UK led by Dr. Adam White of Oxford Brookes University, and a Brain Bank led by Dr. Gabriele DeLuca of Oxford University.

Dr. White recently completed a research project into athletes and caregivers’ experiences of CTE, working alongside the Concussion Legacy Foundation and Boston University CTE Centre.

The UK Brain Bank’s launch is accompanied by a 24-hour outreach hotline, education and peer support mentors and groups, with people also being connected with medics and clinics.

“When we first started the Foundation, goal number one was to start a Brain Bank,” says Dr Nowinski.

“Part of the reason concussion and brain trauma has been under the radar for so long is that there hasn’t been visual proof of damage. Without pathology, we can’t get this evidence.

“We want to create undeniable proof and show this unique disease under the microscope and show how it is destroying the lives of athletes now.

“We want the whole world to be working on this, the best scientists in the world, and we need this to be across the world if we want to have hope for treatment in our lifetime.”

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Royal Rehab opens Australia’s largest technology centre

The centre caters for people living with disabilities across the country

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Royal Rehab, Australia’s not-for-profit provider of rehabilitation and disability support services, opens the country’s largest technology centre, providing Australians with access to a comprehensive range of technology.

Royal Rehab’s Advanced Technology Centre is a purpose-built hub designed to improve the rehabilitation outcomes of people impacted by life changing illnesses or injuries. The centre also caters for people living with disabilities, by providing expert support and access to technologies that aim to improve function, strength and wellbeing and is the largest of its kind in Australia.

The C-Mill VR+ technology combines a treadmill with body weight supports and virtual and augmented reality to improve balance, gait, and gait adaptability in a controlled environment. The device provides a safe and comfortable training environment that mimics the challenges of real-life, helping users to navigate situations like walking in crowded areas and avoiding obstacles.

The centre is also home to a Zero G Gait and Balance System, which has the longest walking track in the country. This device is a robotic body weight support that is designed to assist those affected by spinal cord injuries, brain injuries, neurological conditions and degenerative conditions to walk.

It allows falls prevention training to minimise patient risk, so they can focus on regaining their confidence in walking, balancing, climbing stairs and manoeuvring from sitting to standing positions.

Matt Mackay, CEO of Royal Rehab, believes technology can play a significant role in unlocking better patient outcomes and that the opening of Royal Rehab’s Advanced Technology Centre will make innovative technology more accessible.

“We know that the use of technology in combination with traditional therapies has the potential to drive better outcomes,” he says. “This will revolutionise the rehabilitation pathway for many patients, which in turn can lead to dramatic changes in a person’s quality of life.

“Our Advanced Technology Centre provides Australians with the opportunity to access potentially life-changing devices, many of which have never been accessible in Australia until now. We are delighted to be able to provide patients access to emerging advanced technologies that has the potential to accelerate rehabilitation progress and help people to improve their function, mobility and strength, the CEO adds.

“We want to provide people living with a long-term disability access to these technologies, so they too can benefit from improved strength and fitness, and maintain or even improve their functional independence.”

Jason Redhead, senior physiotherapist and technology lead at Royal Rehab, says that the centre offers Australian patients exclusive access to advanced technologies that will provide greater opportunities to achieve their rehabilitation goals, adding: “We have seen that advanced technology is starting to play a leading role in rehabilitation programs in many other countries.

“We want to ensure Australians too can access the best technology, like robotic exoskeletons, body weight support systems, upper limb robotics and virtual reality technologies. This means we will see more patients achieve more in their rehabilitation goals.”

The centre operates under the Royal Rehab LifeWorks banner, which provides Australians with access to a multidisciplinary team of allied health clinicians who work together with patients and clients on their individualised goals to develop integrated therapy and wellness programmes.

Royal Rehab’s Advanced Technology Centre is located at their Ryde location and will open its doors on July 1. Access to the centre is covered under a range of funding options, including NDIS, iCare, and self-funding.

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Neuro Convention returns next week

The event brings together neuro-rehab professionals and leading organisations from across the UK

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Neuro-rehab professionals and organisations will be attending one of the key dates in the sector calendar next week – Neuro Convention 2022. 

The event showcases the latest technology and innovations in the neurological sector, with the goal of improving patient outcomes. 

Neuro Convention, held on Wednesday and Thursday at the NEC Birmingham, will focus on four key areas – rehabilitation, mental health, diagnostics and brain and spinal injury. 

The free event includes a programme of more than 50 free CPD-accredited seminars, hosted by leading experts from across neuro-rehab, as well as interactive workshops hosted by the specialist neuro-rehab team at the University of Plymouth. 

Technology will also be showcased, with a programme of live demonstrations, to show how the latest innovation can benefit people’s lives. 

More than 50 exhibitors will also be in attendance, including the team from NR Times, who can be found on stand N-G3. 

Neuro Convention will be co-located with Naidex and UK Care Week within the NEC, highlighting the shared dedication of all three events to improve mobility and the technology introduced to support independent living.

Deborah Johnson, editor of NR Times, who will be attending Neuro Convention, said: “Neuro Convention is known as being one of the must-attend events in the neuro-rehab calendar, and 2022 looks to be another excellent event, with a packed programme of speakers and workshops and an array of leading exhibitors. 

“It’s absolutely fantastic that the opportunities for the neuro-rehab sector to come together again in person are returning, and I’m personally looking forward to meeting as many people as possible – those who are new to NR Times, others who are old friends, and those who to date we have only met via Zoom!” 

Tickets are free and to register, visit here. 

SHOW INFO 

Dates & Times 

Wednesday 6th July 2022 | 09:30 – 16:30

Thursday 7th July 2022 | 09:30 – 16:00 

Venue Address 

Hall 19

National Exhibition Centre (NEC)

Birmingham

B40 1NT, UK

Social links #NeuroCon

https://www.facebook.com/neuroconvention

https://twitter.com/NeuroConvention

https://www.linkedin.com/company/european-neuro-convention/

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Role of sleep in memory and learning uncovered

Research findings could aid development of assistive tools for people with neurological injury or disease

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New research into sleep may help explain how memories are formed and how learning is consolidated, and could aid the development of assistive tools for people affected by neurological injury or disease. 

Scientists previously studying laboratory animals discovered a phenomenon known as ‘replay’ that occurs during sleep – a strategy the brain uses to remember new information. 

Scientists believe that this replay of neuronal firing during sleep is how the brain practices newly-learned information, which allows a memory to be consolidated, and converted from a short-term memory to a long-term one. 

However, replay has only been convincingly shown in lab animals.

Now, a new study has investigated whether replay occurs in the human motor cortex — the brain region that governs movement — focusing on a 36-year-old man with tetraplegia who cannot move his upper and lower limbs due to a spinal cord injury. 

The man, identified in the study as T11, is a participant in a clinical trial of a brain-computer interface device that allows him to use a computer cursor and keyboard on a screen.

The investigational device being developed by the BrainGate consortium, a collaborative effort involving clinicians, neuroscientists and engineers at several institutions with the goal of creating technologies to restore communication, mobility, and independence for people with neurologic disease, injury, or limb loss.

In the study, T11 was asked to perform a memory task similar to the electronic game Simon, in which a player observes a pattern of flashing coloured lights, then has to recall and reproduce that sequence. 

He controlled the cursor on the computer screen simply by thinking about the movement of his own hand. Sensors implanted in T11’s motor cortex measured patterns of neuronal firing, which reflected his intended hand movement, allowing him to move the cursor around on the screen and click it at his desired locations. 

These brain signals were recorded and wirelessly transmitted to a computer.

That night, while T11 slept at home, activity in his motor cortex was recorded and wirelessly transmitted to a computer.

“What we found was pretty incredible,” said Dr Daniel Rubin, lead author and a neurologist at the MGH Center for Neurotechnology and Neurorecovery. 

“He was basically playing the game overnight in his sleep.

“This is the most direct evidence of replay from motor cortex that’s ever been seen during sleep in humans.”

Most of the replay detected in the study occurred during slow-wave sleep, a phase of deep slumber. 

Interestingly, replay was much less likely to be detected while T11 was in REM sleep, the phase most commonly associated with dreaming. 

The researchers see this work as a foundation for learning more about replay and its role in learning and memory in humans.

“Our hope is that we can leverage this information to help build better brain-computer interfaces and come up with paradigms that help people learn more quickly and efficiently in order to regain control after an injury,” said neurologist Dr Sydney S. Cash, co-director of the Center for Neurotechnology and Neurorecovery at MGH.

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