When it comes to concussion one of the hardest things for clinicians to achieve is a comprehensive diagnosis.
This makes it even harder for those working in contact sports to achieve this, with time usually of the essence when an assessment is made mid-game.
Re:Cognition Health is one firm looking to make progress in this area and is doing so through a number of technological innovations.
Recently the company has taken a particular focus on creating a device that can diagnose one of the most common conditions brought on by contact sports in chronic traumatic encephalopathy (CTE).
This is a gradual condition which develops after repeated blows to the head, which starts with symptoms like short term memory loss and mood changes, before becoming more serious with things like tremors, slurred speech and dysphagia.
A lot of the symptoms that develop are similar to those of neurodegenerative disease like Parkinson’s and Alzheimer’s, which are often outcomes for those with CTE.
Dr Emer MacSweeney, CEO of Re:Cognition Health, explained how the company is working to overcome these diagnostic difficulties.
“The big thing at the minute is the impact of both single blows, but more importantly, the repetitive blows to the head that appear in contact sports,” she told NR Times.
“We’ve been working both on managing the clinical symptoms and looking at the types of symptoms that correlate, particularly with this condition that everyone is really concerned about.
“Up to this point, one of the big problems has actually been being able to diagnose it using objective biomarkers.
“One of the areas where we’ve really been pushing the boundaries is through the work to demonstrate evidence of CTE using very sophisticated forms of MRI sequences.
“This provides offline manipulation of data that will give us evidence of this type of structural brain injury, which is not visible using current conventional MRI.”
Over recent years Re:Cognition Health has worked with a number of professional rugby players to help learn more about CTE.
This mainly includes those who are retired as this is when symptoms usually start, but it has worked with players as young as in their 20s to get a full understanding of how the condition develops.
Its research is now being put into practice through the use of diffusion tensor imaging (DTI), which is providing this objective evidence for the condition.
This marks a major milestone in the treatment of the condition which has largely been unknown until recent years, having been named ‘punch drunk syndrome’ in the past due to its prevalence in former professional boxers.
“The most important thing is the fact that at the moment, CTE can only be diagnosed after people die,” Dr MacSweeney said. “What we’re working on is being able to make a diagnosis during life.
“If you can make a diagnosis then you can implement a form of treatment management and you can also measure whether that treatment is being successful.
“But also, if you can identify what the problem is, then you can start to work at the front end and try to implement manoeuvres that will protect the brain from developing these problems in the first place.
Now Re:Cognition Health is beginning to roll out studies to further its knowledge in this area.
This includes one piece of research which will monitor female rugby players who are competing on a national level.
In this they will be fitted with a protective headband which will monitor the impact each player’s brain receives, then using this data alongside Re:Cognition Health’s brain scans to have a detailed look at what damage repetitive head traumas are doing.
Researchers will be able to view each participant’s brain down to a microscopic level while also paying particular attention to what type of head impact is leading to the development of CTE.
Furthermore the study will look at what effect head impacts have on the blood-brain barrier and how this leads to the build up of abnormal proteins, one of the main known causes of dementia.
Re:Cognition Health is always looking at the other end of the spectrum and studying retired rugby players who are showing signs of developing these neurodegenerative conditions.
This will help the firm determine how effective current treatments are for these diseases.
However all of this is designed with the ultimate goal of coming up with a method of clinical diagnosis for conditions like dementia.
“For the retired players a diagnosis is essential,” Dr MacSweeney said. “If you know what’s wrong, then you’ve got a much better chance of doing the right thing to try to intervene in a way that’s meaningful and directed.
“For the younger players who are playing now, it’s incredibly important because what is most likely is that it’s not either one or two big concussions causing this.
“It is all these multiple small hits but not everyone is necessarily going to be as susceptible to developing these conditions as everybody else.
“What is most likely, is that there’s a threshold like in most things.
“There will be a certain amount of minor trauma to the head, which becomes cumulative and will reach a threshold point at which it’s going to be essential that a player should rest.
“Because this is such a big problem we want to give people the choice to understand what’s happening to their brain but secondly to allow them to continue to play in a much safer way.”
Re:Cognition Health brings together experts on all different types of brain conditions together to help its research.
The topic of neurodegenerative diseases in relation to sport has only started to hit the headlines in the last few years, but Dr MacSweeney says it isn’t a new issue.
“Has this suddenly become a problem or is it that we haven’t been noticing it? It’s a combination of two.
“The way the players, particularly those at higher levels, are training now is so different to what it was 15 years ago.
“Things like frequency they practice at and the actual weight of players has significantly increased, meaning the repetitive trauma that the players are being subjected to is much greater.
“Knowledge brings a problem like this to the surface but I don’t think anyone’s ulterior motive is to prevent the game, it’s to play safely.”
