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Brain injury

‘Revise way concussion is viewed to achieve real change’

“We’re getting it wrong in society and healthcare,” says Dr Adam J White of the Concussion Legacy Foundation UK

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Views of concussion in society must be altered, alongside much-needed revision of protocols in sport – particularly at grassroots – if change in how head injury is viewed and dealt with is truly going to happen, says Dr Adam J White, executive director of the Concussion Legacy Foundation UK. NR Times learns more

 

Since the launch of the UK chapter of the Concussion Legacy Foundation (CLF) last month, its accompanying helpline has seen huge demand for support from veterans and amateur athletes concerned at the impact of their head injuries and the implications of sustaining them.  

The CLF has set ambitious targets to prevent new cases of Chronic Traumatic Encephalopathy (CTE) within five years and of finding a cure by 2040. 

And in being able to achieve that, Dr Adam J White, executive director of CLF UK, says as well as making the necessary changes within sport to protect players, concussion must also be recognised for its seriousness in wider society. 

“Concussion is an issue in sport, it’s an issue in the military, but it’s an issue in everyday life. And it’s an area where we’re just getting it wrong in terms of society and healthcare,” Dr White tells NR Times. 

‘We’re not doing enough to support people with mild traumatic brain injuries, they’re falling between the gaps. They’ve got some real complex needs that aren’t being catered for by the NHS in the UK at the moment, and that’s a real worry. 

“Through the helpline, we’ve had a huge number of people seeking help with their concussions and I think more and more people will be presenting to us. And I hope more and more people do, because it’s not trivial, it is important. 

“These are serious injuries, each and every one of them, so they do need to be given support for that condition.

“At the moment, the kinds of guidance they’re getting is inadequate, they’re often being told to go home and rest and are often given very little other information. Depending on which hospital you attend depends on what kind of information you’re going to get.

“Often, there’ll be no further referral or no follow-up, typically you’re told if anything deteriorates come back, but people are often not given any treatment plans or support with a huge raft of needs from motor needs, coordination, headaches, sleep disorders. People are then left to fend for themselves, which can impact significantly on their lives.”

Through the work of CLF in its native United States and its role in establishing the world-leading VA-BU-CLF Brain Bank in Boston – which it is now building further around the world, including in the UK with the creation of the CLF Project – huge advances have been made in understanding the causes of CTE, with links now proven with repeated head impacts over a period of time. 

As a result, CLF’s founder Dr Chris Nowinski – whose exposé of NFL safety protocols in 2006 is credited as revolutionising the sport – has become a leading advocate of the need to protect children from the impact of heading. 

“Delaying heading as much as we can to restart it much later is a really great first step,” says Dr White. 

“By saying there will be no heading until 14 or 16 or 18, we’re reducing our exposure, which would be fantastic. It’s not a core component of the game. It could be removed and most of the game would maintain its beauty, its fun, its enjoyment. So that could be a great first step. 

“Sport is a difficult nut to crack but we can affect changes. We’ve given sport five years to stop all new cases of CTE, but we could do it tomorrow. The reality is we know how to make this condition stop, but we need to be bold enough and brave enough to make the change. 

“What we need to do is reduce the exposure, and then making sure that in tandem with that, we are making sure when players do get concussed, that we deal with it properly, so we’re not returning players the same week, we’re making sure they have plenty of time to rest and recover.

“We’re making sure that they’re not putting their brains through lots of extra stress and they’re not coming back to full contract sessions. We need to see all of those those policies and protocols put in place.”

While change is indeed starting to happen, with measures being taken including restrictions on full-contact training in rugby and high-force heading in football training, Dr White says advocacy has a huge role to play in driving this forward further still. 

“I think in terms of preventing this issue in the future, it’s about the players, it’s about the parents and the grassroots game,” he says. 

“Athletes often forget the power they have. If they decide to vote with their feet, if parents decide that they’re not going to let their kids do this anymore, it’ll change. But we’ve seen there has been plenty of opportunity for sport to make the change themselves and they’ve never been brave enough to do it. 

“Now, we’re seeing more and more people saying, no, we’re not going to allow this. People are asking do I want my daughter to be heading the ball, do I want this for my child, and we really need them to continue to do that. Children can do so many other kinds of physical activity and exercise but without the risks.”

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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