Sports-loving scientists with sights set on concussion
There’s growing evidence that contact sport, at any level, puts our brains at risk. Of increasing concern is chronic traumatic encephalopathy, or CTE, a degenerative brain disease found in athletes, military veterans, and others with a history of repetitive brain trauma.
CTE is associated with early-onset dementia. However, one of the big challenges facing researchers is that CTE can only be diagnosed in brain tissue after death, leaving many unanswered questions.
Sports-related head injuries account for only 20% of concussions (the vast majority are the result of falls) but they’re of great importance to neurological research as little is known about mild traumatic brain injury (mTBI) — the smaller head knocks.
MTBIs can occur hundreds or thousands of times over a player’s career. Neuroscientists are keen to understand if this can lead to disease or change how a person thinks, acts, and feels.
The Neurological Foundation is funding three researchers at different institutions to study head injury and sport. Curiously, they are all passionate players and coaches of sports where head knocks are common.
DR HELEN MURRAY, neuroscientist and national ice hockey representative
Dr Helen Murray is the country's most knowledgeable CTE expert, and a forward (and former captain) of the Ice Fernz, the national women’s ice hockey team. She has been awarded a Neurological Foundation Senior Research Fellowship.
Based at the Neurological Foundation Human Brain Bank at the University of Auckland, Dr Murray aims to reveal new knowledge of CTE by comparing 30 precious brain tissue samples collected post-mortem from 10 cases of confirmed CTE, 10 cases of AD, and 10 healthy controls.
“We have the incredible resource of tissue donated to the Sports Brain Bank in Auckland, and we are fortunate to have the support of the UNITE Brain Bank in Boston and the Australian Sports Brain Bank, where we are also sourcing samples,” says Helen.
Her study is using a novel method of tissue labelling, called multiplexing, to see 50 different proteins on the same piece of brain tissue. The disease can then be explored from different angles, all at once, making the most of the incredibly precious gift of human brain tissue.
Her goal is to find biomarkers – biological molecules that distinguish CTE and AD. Ideally these biomarkers could eventually be measured in blood samples so that a simple blood test could then diagnose the condition in patients.
“When I talk to patients they just want to know what the future looks like for them. A diagnosis of CTE or Alzheimer’s are two very different things. We need to fill that gap in between, and that takes long-term research.
Helen remains acutely aware of the risk inherent in contact sport. Earlier this year she suffered a sub-concussive head knock – one of many she has sustained over the years – when she fell backwards during a hockey match, whacking her head on the ice.
“I had my helmet on and I didn’t feel that bad, but I thought, ‘no, I'm not going to push this’. I sat on the bench, and I just watched my team play the rest of the game. I thought, ‘you know, this is why I do this work’. We don’t know what those small knocks do to our brains.”
DR JOSH MCGEOWN, former club rugby, American football and ice hockey player, and neuroscientist
Dr Josh McGeown is part of a team collecting real-time data from rugby players to advance our understanding of how repetitive head impacts might change the brain over time. He is based at the Mātai Research Institute in Gisborne.
Players from the 1st and 2nd XVs at Gisborne Boys’ High School have agreed to take part in the study. Using advanced imaging techniques, Dr McGeown has been scanning their brains at the beginning, middle, and end of the season to pick up any subtle injuries, and is wrapping up his second season of data collection.
The project is jointly funded by the Neurological Foundation, the Hugh Green Foundation, an HRC Explorer Grant and an anonymous donor.
“The school, the players and their families have gotten completely behind everything we're doing, which is basically trying to answer the question, ‘does a season of hits to the head from participating in rugby change the brain, even in the absence of a clinically-diagnosed mild traumatic brain injury or concussion? So, how did those little knocks pile up over time?’” says Josh.
All players wear mouthguards that are fitted with sensors to record both gentle and significant head impacts during training and games. The MRI images and mouthguard data are then analysed side-by-side.
“While some players might be diagnosed with concussion during the season, mouthguard data will help understand if other players still experienced changes related from minor head knocks,” Josh says. “It means we can go beyond just the brain imaging, to look at an individual player or certain aspects of gameplay."
Josh’s research is focusing on whether we can ‘see’ changes in the brain resulting from mild traumatic brain injuries (mTBIs). The preliminary data from Josh’s study suggests one season of rugby may be related to changes in the brain of a young person.
“But that’s not the whole result. The real question is, what does recovery look like? We need to evaluate things like, if the player takes four or eight weeks off, then do things start going back to normal?
“With better evidence and data, we can work with coaches, referees and unions to identify aspects of the game that are most strongly associated with mitigating risk and maximising benefit.
“My focus is the solutions. And telling people you can’t play sport is not a solution.”
PROFESSOR NICK DRAPER, Professor of Sport and Exercise Science and junior rugby coach
Professor Nick Draper from the University of Canterbury leads a two-year study into the potential of World Rugby-approved headgear to reduce collision forces at amateur level.
As well as providing new information about the number and size of collisions in rugby, it focuses on female athletes. Some wear World Rugby headgear and others choose not to.
Like Josh’s research, the players have pre- and post-season MRIs along with neurocognitive assessments, and wear instrumented mouthguards during training and matches.
The Neurological Foundation funds the portion of the research involving participants from Prebbleton U17 and Christchurch Girls’ High School 1st XV. More recently, additional funding from Pacific Radiology Group and from the Maurice and Phyllis Paykel Trust was secured to include Selwyn Schools Combined 1st XV in the study.
“No research exists for teenage rugby players in these important areas of athlete safety and health,” says Professor Draper, who is an exercise scientist with a background in rugby and judo. Notably, he managed the British judo team at an Olympic level, and coaches junior rugby in Christchurch.
“Rugby union is played by 7.7 million people in 129 countries. Given the significant risk of concussion associated with collisions in rugby, especially for junior players, our research is of wide-reaching significance,” Professor Draper says.
His results will be available early in 2024.