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Brain injury

Groundbreaking study tackles dementia risk in footballers

BrainHOPE builds on the FIELD study to find potential ways to reduce neurodegenerative disease in sport

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A new landmark research study will investigate possible ways to reduce dementia risk in former professional footballers.

The BrainHOPE study builds on the groundbreaking findings of the FIELD study, which found risk of dementia and related disorders among former professional footballers was around three and a half times higher than expected.

BrainHOPE (Optimising Brain Health Outcomes in former Professional and Elite footballers) – led by the University of Glasgow, in collaboration with the University of Edinburgh, Imperial College London and the wider PREVENT Dementia research collaborators – will use brain imaging and a range of tests to compare brain health in mid-life former footballers to general population control subjects already recruited to the PREVENT Dementia study.

In addition, in a world’s first, researchers will explore whether any differences in brain health among footballers might benefit from management of known dementia risk factors designed to try and their reduce risk.

To do this, BrainHOPE – a £1.3million, four year study, jointly funded by the FA and FIFA – will recruit 120 former professional footballers aged 40 to 59, to compare against 700 general population controls. 

The effectiveness of Brain Health Clinic management will then be explored within the footballer subjects, with the brains scans and tests repeated again after two years.

Prof Willie Stewart, BrainHOPE lead, consultant neuropathologist and honorary professor at the University of Glasgow, said: “This is an incredibly important study, and we are grateful to the FA and FIFA for their support to allow it to proceed. 

“Our findings from the FIELD study show there is reason to worry about lifelong brain health in former footballers. 

“BrainHOPE is designed to identify tests that might detect problems early on and, more importantly, possible ways to try and reduce dementia risk for former footballers.”

Prof Craig Ritchie, BrainHOPE co-lead, chair of the psychiatry of ageing and director of Edinburgh Dementia Prevention at the University of Edinburgh, and lead on the PREVENT Dementia Programme, said: “This is such an important study aligned to the main PREVENT Dementia Programme and solidifies an exceptionally strong academic collaboration between Universities of Edinburgh and Glasgow and Imperial College London. 

“This work will help us understand in detail the association between playing football and brain health and in doing so have a great impact on the wellbeing of current and retired players.”

Charlotte Cowie, head of performance medicine at the FA, said: “The launch of the BrainHope study is another important step in building our understanding of the long-term health of former professional footballers. 

“Forming part of the wider Prevent Dementia study, this research will help us further understand the links between the game and neurodegenerative diseases and also potential early interventions which could help reduce risk or speed of developing dementia.”

The 2019 FIELD study – led by Prof Stewart – remains the largest study to date looking in detail at the risk of neurodegenerative disease in any sport, not just professional footballer players.

The study compared health records of 7,676 former Scottish male professional football players who were born between 1900 and 1976 against those of more than 23,000 matched individuals from the general population. 

Neurodegenerative disease risk among former football players relative to matched controls was then calculated for a range of player positions and career lengths and for decade of birth.

In parallel work led by Prof Stewart, a specific pathology linked to brain injury exposure, known as chronic traumatic encephalopathy (CTE), has been described in a high proportion of the brains of former contact sport athletes, including former amateur and professional footballers.

Former professional football players interested in participating in this research should visit https://preventdementia.co.uk/prevent-sports/

Inpatient rehab

Brain injury survivor fundraises for The Walton Centre

Karen Parry’s running club is fundraising for the specialist centre which saved her life

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A woman whose life was saved by The Walton Centre after an accident at home has inspired a fundraising initiative on behalf of the nationally-renowned specialist centre.

In December last year, Karen Parry was making her way up to bed when she fell down the stairs, hitting her head on the hall floor. 

Karen, from Prescot, was rushed to the Aintree Trauma Unit before being transferred to the neighbouring Walton Centre for life-saving brain surgery. 

“It was one of the most terrifying nights of my life,” recalls Karen’s husband, Gavin. 

“Karen was badly hurt, but I didn’t realise how badly until I was at The Walton Centre speaking to the anaesthetist about the emergency surgery she was going to have. 

“Mr Rasheed Zakaria and his surgical team saved Karen’s life, but they also took the time to calmly and compassionately explain Karen’s condition to me along with the steps they would be taking.”

Karen made it through the surgery at the pioneering Walton Centre and was put in a medically-induced coma to allow her brain to recover enough to be woken up later.

“I was visiting Karen in ICU every day with special permission due to the severity of Karen’s condition,” Gavin continues. 

“When I came in the day she was being brought out of her coma, I found her dedicated nurse brushing her hair, she said it was because removing the tangles would have hurt her when she was awake. 

“I thought this was very kind and thoughtful. They cared so well for her, it was outstanding.”

The 52-year-old spent over two weeks in ICU, having further corrective procedures before moving to a ward to recover further – spending Christmas in hospital.

Gavin said: “Karen had been assisted into the chair at the side of her bed for our visit, which was great to see. 

“At this stage Karen was too weak to spend much much more than half an hour sat upright and we were all really happy to be with each other.

“It was a lovely visit and we were sad to leave. As on any other day the staff were busy but lovely and kind.”

Then March this year, Karen was able to return home, after receiving rehabilitation with the Cheshire and Merseyside Rehab Network, hosted by The Walton Centre.

“Karen was so determined to get better, she’s so tough,” said Gavin.

“She kept getting stronger. The Walton Centre continued to support her. Mr Zakaria, the neurosurgeon who saved her life, sent a detailed letter to her GP to ensure they knew exactly how to support Karen when she did come home.”

While Karen was in hospital, her local running club Knowsley Harriers nominated The Walton Centre Charity as their charity of the year. 

Karen is Treasurer of the club and an avid running coach. Each month the club hosts ‘The Walton Centre Charity’ 5km run, which encourages members and non-members to donate to the charity. 

So far they have raised nearly £900 this year, and will continue to do so for the rest of 2022.

Gavin added: “The club has a number of links to the hospital, from other members who have previously been looked after there. We were delighted when they picked The Walton Centre Charity. 

“This was a very frightening time for my son and myself and very much a rollercoaster ride of emotions explained to us when Karen entered the unit. 

“Sadly, Karen remembers very little of her time in The Walton Centre but I have reminded her of the wonderful care which she has received.

“The nurses, doctors and therapy staff are truly inspirational, not only for their professionalism and incredible skills as medical practitioners but they also have the kind of qualities that cannot be taught in a classroom – care, love, kindness, understanding and humanity – they have them in abundance.”

Karen said: “Sadly, I remember little about my time in The Walton Centre due to the nature of my head injury. Gav has spoken to me at length about the wonderful people that cared for me there. I would just like to thank them all from the bottom of my heart.”

To donate to the fundraising appeal, visit https://www.justgiving.com/fundraising/khac2022

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Brain injury

Fact-finding tour helps creation of ABI Strategy

Chris Bryant MP and UKABIF visit three key neuro-rehab sites nationally

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Efforts to gather information which will help in the creation of the new Acquired Brain Injury (ABI) Strategy have been boosted through Chris Bryant MP’s visits to key neuro-rehabilitation sites around the country. 

The MP – chair of the All Party Parliamentary Group (APPG) on ABI, who has been instrumental in securing the go-ahead from the Government to create the Strategy – visited sites in Newcastle, Sheffield and Birmingham to gain greater insight into what provision exists and what more is needed. 

The Strategy has been hailed as being of vital importance in helping to support people living with brain injury and to help level the disparity in provision across the country.

Chris – also co-chair of the ABI Strategy Programme Board – visited Walkergate Park in Newcastle with UKABIF’s chief executive, Chloe Hayward, who is co-chair of the Strategy’s Patient and Public Voice Reference Group. 

The Tyneside centre provides neuro-rehabilitation and neuropsychiatry services for adults with a disability caused by injury or disease affecting the brain or spinal cord.

They met with staff and patients at the 64-bed centre, learning about the range of rehabilitation offered by its specialist neuro-rehab team, and the equipment and technology available to help people affected by ABI to live as independently as possible.

In Sheffield, they visited Steps rehabilitation centre, which provides 23 rooms for residential rehabilitation, and offers everything from hydrotherapy to music therapy, alongside the latest technology to benefit patients’ lives. 

On their trip to Birmingham Women and Children’s Hospital, to see what rehabilitation services are available for children, Chris met with staff, patients and families on a tour of the city centre hospital and also spoke with The Child Brain Injury Trust.

At each location, staff and patients were given the opportunity to say what they thought was needed to improve the lives of those living with ABI.

“These visits have been hugely helpful as we look to gather information and first hand views from people working in ABI neuro-rehabilitation,” said Chris, whose Private Members’ Bill led to the Government granting approval for the creation of the ABI Strategy. 

“If the ABI Strategy is to be fit for purpose, we need to know what is currently working, but perhaps more importantly, what isn’t working in order to ensure the needs of people with an ABI are properly addressed.

“I want to say a huge thank you to everyone we met for sharing their experiences for us to consider as we take the Strategy forward.

Chloe Hayward said: “Being able to see and speak to both staff and patients means we have real life experiences from people. 

“As co-chair of the Strategy’s Patient and Public Voice Reference Group, I want to make sure patients’ views are taken into consideration when the Strategy is being established.”

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Brain injury

New therapy reduces veteran headaches after brain injury

Cognitive Behavioural Therapy for Headache also shown to have positive impact on PTSD symptoms

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The first therapy to be developed specifically for post-traumatic headaches significantly reduced related disability in veterans following a traumatic brain injury (TBI), a study has revealed. 

Cognitive Behavioural Therapy for Headache (CBTH) was also shown to reduce co-occurring symptoms of post-traumatic stress disorder (PTSD) comparably to a gold-standard PTSD treatment.

Furthermore, the therapy was shown to be appealing to patients with low drop-out rates, and is easy for therapists to learn and deliver, increasing its potential to be widely used and to improve the lives of servicemen and women and veterans globally. 

CBTH, which uses cognitive behavioural therapy concepts to reduce headache disability and improve mood, includes key components such as relaxation, setting goals for activities patients want to resume, and planning for those situations.

“We are excited by this development in the treatment of post-traumatic headache, which along with TBI is poorly understood and for which treatment options are so limited,” said Dr Don McGeary, associate professor at The University of Texas Health Science Center at San Antonio (UT Health San Antonio). 

“To find the first major treatment success for post-traumatic headache, which is arguably the most debilitating symptom of TBI, and that the treatment also significantly reduces co-morbid PTSD symptoms, is a major breakthrough.”

Both TBI and PTSD are prevalent in post-9/11 military conflicts, and the two conditions commonly occur together. 

Post-traumatic headaches, or headaches that develop or worsen following a head or neck injury, become chronic and debilitating in a large percentage of those who experience a TBI such as a concussion, inhibiting their ability to engage in the activities of daily life. 

When PTSD is co-occurring, it can worsen the headaches and make them more difficult to treat.

Effective treatments exist for PTSD but not for post-traumatic headache, which along with TBI, scientists are still working to understand. 

Migraine medications commonly used to alleviate the headache pain do not relieve related disability. They also often have unwanted side effects, and their overuse can worsen headaches.

In the study, Dr McGeary and his team developed CBTH by modifying a psychotherapy for migraine headaches. They evaluated its efficacy with co-occurring post-traumatic headache and PTSD symptoms.

The study was conducted at the Polytrauma Rehabilitation Center of the South Texas Veterans Health Care System. 

Participants had clinically significant PTSD symptoms and headaches persisting more than three months following a TBI. They were randomly assigned to receive either CBTH, a leading PTSD treatment called Cognitive Processing Therapy (CPT), or the usual care provided at the VA Polytrauma Center.

At the end of treatment, researchers found that, compared to usual care, those receiving CBTH reported significant reductions in disability and in negative impact on function and quality of daily life. 

They also showed improvement in PTSD symptoms comparable to the group that received CPT. All of these treatment gains were maintained six months after treatment completion.

CPT, on the other hand, led to significant and lasting improvements in PTSD symptoms, but on its own did not improve headache disability. 

“This was a surprise,” said Dr McGeary. 

“If theories about PTSD driving post-traumatic headache are correct, you’d expect CPT to help both PTSD and headache. Our findings call that into question.”

Interestingly, CBTH did not reduce headache intensity or frequency compared to usual care. 

Dr McGeary said its dramatic reductions on negative life impact are likely due to its building patients’ confidence that they could control or manage their headaches, a concept known as “self-efficacy.” 

That sense of control was key to helping patients “get their lives back,” he said.

“If you can improve a person’s belief that they can control their headache, they function better,” Dr McGeary said. 

“That’s because, when dealing with a long-term, disabling pain condition, people make decisions about whether they’re going to actively engage in any kind of activity, especially if the activity exacerbates the pain condition. 

“They make those decisions based on their perceptions of their ability to handle their pain.”

In comparison to CPT, CBTH requires fewer and shorter therapy sessions—typically eight sessions of 30-45 minutes each. CPT typically involves 12 sessions lasting 60-90 minutes each.

CBTH requires only two hours to train clinicians to deliver the therapy, compared to CPT, a complex treatment that requires significant training and acquired skill. 

The research team now hope to broaden their study to be as representative as possible. 

Dr McGeary said: “We need more women, more racial and ethnic diversity, veterans as well as active military of different branches, with varying comorbidities, in different geographic regions attached to different hospitals and medical systems because we’re comparing to usual care.”

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