Brain health publications

We are part of  the Traumatic Brain Injury Network and are researching ways that are contributing to brain health. Please find below the publications that outline individual projects further:

  • Hume 2019 NZJSM V45-2 pg 78-82 Selected Abstracts
    Concussion carries with it a lot of stigma in sport and is colloquially referred to as a head-knock or bell-ringer, undermining the seriousness of the injury. While all concussions are mild traumatic brain injuries, not all mild traumatic brain injuries are concussions although these terms are used interchangeably. Therefore, experts have proposed that sport-originated brain injury (SOBI) is used to describe sports-related concussions.

Measurement

  • Le Flao 1SBS 2018
    Developments in wearable technologies should enable us to improve concussion identification and even prevention however, to date, data usage has been restricted.
  • King 2017 Head impact exp match womens RL 1 domestic comp JSciMedSport
    Impact monitoring ear patches revealed that, in women’s amateur rugby, sub-concussive head impacts were more common in forwards than backs and these impacts were of higher magnitude. Most impacts occurred on the side of the head and were sustained during the second half of the game.
  • King 2016 Sports Med influence head impact
    Thresholds of 10-30g are used to identify notable impacts in sport. In 38 amateur rugby players, over 20,000 impacts were recorded over the course of a season. The implications of this are unclear and it may be that raw data has more value, but this is yet to be validated.
  • King 2016 Similar head impact accel ear patch jnr rugby union JNeurosurgPediatr
    In four U9 junior rugby matches there were 4 concussions and 721 head impacts >10g. Of these, 17% were above the rotational injury risk limit and 0.1% were above the linear injury risk limit. Head movement in these NZ players was, overall, higher than in junior American Football players
    N = 14 M
    XPatches
  • King 2016 peds16-84_author_proof
    Over a season of 12 matches, a team of U11 Junior rugby players sustained an average of 13 head impacts greater than 10g per game. Median impact was 16g, with 95% of impacts less than 57g. This and the rotational impact was similar to that recorded in American Football, but occurred at a younger age and lower body weight. This could be due to the tackling rules in rugby league.
    N = 19 M
    XPatches

Incidence

  • King 2018 Inj rugby 1 to 5 concussion NZJSM 45-1 pg 22-33
    During an amateur rugby season, an average of 4 injuries per match were recorded, of which one was a concussion. Less than 20% of these were witnessed and only identified after the match with the SCAT and KD tools.
    N = 71 M
    Senior RU
  • King 2018 Concussion SnrRL NZ SportsMedRehabJ
    Amateur representive players sustain more than twice as many concussions as premier domestic players. Concussions to the ball-carrier are three times as likely as concussions to the tackler. Most injuries occur in the last quarter of the match.
    Senior RL
  • King etal 2018 Sports injuries NZ ACC 5 sports 2012T16 BJSM
    Rugby Union is responsible for the most serious and severe concussions out of the most popular NZ team sports; rugby, football, netball and cricket. Claims by females however, were three times as high in football than rugby and twice as high as in cricket. The number of claims for head injuries is increasing over time.
  • King 2016 Semi-Prof rugby league concussion pooled analysis SportsMed
    A review of 25 studies that included male, female, amateur, professional and junior rugby league players revealed that amateur players have the highest incidence of match time concussions (1 every 40 games) and professional players have the highest incidence of training time concussions.
  • Lopez 2017 Injury rates in rugby 7’s
    N = 960 M & 888 F
    RISE report
    This is one of the first studies to report time loss due to injury in rugby. A total of 244 injuries were sustained over eight days of sub-elite Rugby 7’s tournaments resulting in a loss of 60 hours of play per 1000 hours. Backs sustained more injuries than forwards, with most of these injuries sustained by men. The concussion rate was 6%. This study provides valuable information in the guidance of injury prevention protocols in US rugby.

Epidemiology/Injury risk

  • King 2019 ACC TBI JNS
    Moderate concussions are most likely to be caused by falls (41%) and serious or severe concussions by car accidents (36% and 56%, respectively). Despite these injuries costing ACC $300 million per year, little is known about the long term effects.
  • King 2017 RESQT NZJSM 43-2 p57-63
    Players with high stress scores were more likely to get injured over the course of a rugby season.
    N = 30
    Senior
    Amateur RL
  • Hume 2017
    366 retired elite and community rugby players and a non-contact sport group were assessed for cognitive function. Compared to the non-contact sport group, the elite players performed worse in attention, speed and switching tasks. Community players also performed better in attention. A history of concussions also significantly reduced scores. These results indicate long-term effects on mental ability and have implications for concussion management at the time of injury.
    N = 366 M
    Age = 43±8

Rehabilitation

Diagnosis/Tools

  • King 2018 Brain Gauge IPPR-18-4361
    The Brain Gauge is a 20 minute test involving a battery of tactile tasks that assess reaction time, amplitude discrimination, temporal order judgment and duration discrimination. A case study of a female patient revealed that, compared to normal scores, the Brain Gauge was sensitive; tracking concussion symptoms and recovery.
    A patient with a history of sports-related concussions underwent a rigorous neurological assessment using the Neary Protocol. This revealed that the patient’s symptoms were a result of underlying balance and dizziness conditions. Patients with a history of concussions should undergo proper testing to ensure the most appropriate treatment and prevent long-term issues.

Mechanisms

  • Lewis 2017
    Brain injury affects the ability to stimulate movement. Whether this persists long-term is unclear. The brains of elite and community ex-rugby players were artificially stimulated to produce movement. Compared to players from non-contact sports, a bigger signal was required to produce a reaction in the elite players, indicating some long-term damage. Interestingly, there was no difference between the elite and community players despite them having experienced a similar number of concussions.
    N = 73

Biomechanics

Reccommendations

  • Quarrie 2017 Facts and values in children's rugby
    There is a debate regarding whether the tackles and collisions permitted in schools’ rugby represent acceptable risks, and what steps should be taken if they do not. Based on injury surveillance data, the risks to children playing rugby do not appear to be inordinately high compared with those in a range of other childhood sports and activities, but better comparative information is urgently needed.
  • Reid 2019 Concussion Study Reports to ACC
    The ‘Sports Concussion in New Zealand ACC National Guideline’ was released in 2014. The KAB studies aim to assess current knowledge and attitudes of secondary school students, coaches, parents, referees, equestrian riders and health professionals towards concussion in sport following release of the guideline.
    • Report 1, Referees - show positive attitudes towards correct management of the injury. There was a general consensus of the referees that further education for players, coaches and referees is required to optimise management and improve the awareness of concussion
    • Report 2, Students - require more education, ideally supported by their sports club on concussion symptoms and the time-frame of their onset, the potential risks of wearing head gear, recovery and return to play and the impact of suffering multiple concussions.
    • Report 3, Parents - suggest that the parents of school children involved in coached sports have some knowledge regarding concussion and show positive attitudes towards correct management of the injury, but there are large gaps in their knowledge.
    • Report 4, GP’s - most GPs and UCPs in this survey have good knowledge of sports related concussion but are lacking confidence in the overall management, particularly with regards to timeframes to return to sports
    • Report 6, Physiotherapists - Physiotherapists in this survey are very knowledgeable regarding concussion and show positive attitudes towards correct management of the injury. They are very good at recognising the key signs and symptoms.

Brain Health Current projects/upcoming papers

  • Le Flao 2019 A review of 15 years of head impact monitoring in sports (under review)
    Two decades of measuring head impacts on the field using instrumented helmets, mouthguards or patches increased the awareness around concussions. Head impacts frequency and magnitude were influenced by age, sex, game/practice, impact mechanisms and player position. The instruments present many limitations and a consensus needs to be found to improve our methods to hope to increase the prevention of head impacts.
  • Le Flao 2019 Validation of the CSx instrumented mouthguards
    A three-part validation study of the CSx instrumented mouthguard (CSx Inc., Auckland, NZ) is on-going. (1) First, the accuracy of the embedded accelerometer and gyroscope were evaluated in the lab. (2) The analysis of data collected during a full season of rugby was analysed and identified major issues. After improvements from the developers, (3) a study will assess their validity by comparing to video footages during combat sports.
  • Renata PhD candidate
    Research explores how data analytics and machine learning/AI can provide a personalized approach for concussion diagnosis and rehabilitation management. Appropriate machine learning algorithms and models will be utilized and developed to analyse multimodal data to better diagnose, effectively predict, and inform the severity, management and long-term effects of concussions.

SKIPP Publications

  • Campbell et al (2019) bjsports-2018-099547.full
    Artistic gymnastics has a high level of injury. A review of 22 studies revealed that the prevalence of injuries was between 2-4 per year. The higher level a gymnast competed at, and the more competitions they entered the more likely they were to sustain an injury.
  • Thomas and Bradshaw ISBS2019 Paper v7 17.04.2019 final submission version
    Of 16 pre-competitive gymnasts aged 5-8, seven made it to the advanced level. Of a variety of performance tests undertaken at the early stage, the drop jump; a test of explosive strength and power, was the best predictor of progression to advanced gymnastics.
  • Bradshaw 2018 The Science of Gymnastics: Advanced Concepts
    Dr Liz Bradshaw has recently contributed to two chapters in The Science of Gymnastics: Advanced Concepts. The first is on Advanced Applied Example of Motor Control and the second is titled Monitoring Gymnasts for Injury Prevention. This chapter explains the pros and cons of monitoring gymnasts for injury prevention and describes subjective and objective monitoring methods and tools. It enables the reader to develop injury prevention and rehabilitation system for gymnasts.

Ethics for projects

  • Wells, D., et al. (2018). AUTEC# 18/50 A training intervention to improve professional darts performance: A case study.
  • Hume, P. A. and K. Ducker (2018). AUTEC# 18/9 Effect of water immersion during a swimming training session on the measurement of subcutaneous adipose tissue using ultrasound.
  • Hume, P. A. and S. Iwamoto (2017). AUTEC #16/229 The relationship between injury frequency, performance and body composition in rugby players: Progress report.
  • Hume, P. A., et al. (2017). AUTEC# 17/353 Measurement of cognitive and physical performance during off shore sailing.
  • Millar, S. K., et al. (2018). AUTEC 14/372 The effect of foot-stretcher design on maximal rowing performance.
  • Hume, P. A., et al. (2018). AUTEC # 18/380 Assessment of alternative ankle strap designs and their effects on accelerations experienced during operation of inflatable boats (IRB's) by Surf Lifesavers in New Zealand.
  • Hume, P. A., et al. (2018). AUTEC #18/44: Global RugbyHealth Research Programme: Integration of multimodal imaging techniques for assessment and diagnosis of concussion or mild traumatic brain injury (mTBI).
  • Hume, P. A. and J. McGeown (2018). AUTEC#18/45 Measuring physiological and neurological function during post-concussion syndrome: A case study.
  • Hume, P. A., et al. (2018). AUTEC#18/437 Inter- and intra-hour salivary biomarker (BDNF) fluctuations in healthy participants.
  • Hume, P. A., McGeown et al. (2018). AUTEC# 18/374 - Investigating gender differences and the clinical utility of objective neurophysiological measures for sports-related mTBI.
  • Hume, P. A., Hardaker et al. (2018). AUTEC# 18/375 - Investigating gender differences and the clinical utility of objective neurophysiological measures for sports-related mTBI.
  • Hume, P. A., et al. (2018). AUTEC# 18/46 Assessing the incidence, management and outcomes following sport-related concussion in New Zealand. A cohort study investigating presentations to a sport-concussion service.
  • Hume, P. A., et al. (2017). AUTEC# 18/412 Measurement of cognitive and physical performance during a 24-hour exercise test.
  • Hume, P. A., et al. (2019). AUTEC19/39: The use of intermittent short-term selective head-neck cooling for the management of acute concussion and post-concussion syndrome. Approved in process.
  • King, D., Hume, P.A. et al. (2019). ANZCTR: The use of intermittent short-term selective head-neck cooling for the management of acute concussion and post-concussion syndrome. Australian New Zealand Clinical Trials Registry (ANZCTR).
  • King, D., et al. (2019). HDEC NZ/1/73D1115: The use of intermittent short-term selective head-neck cooling for the management of acute concussion and post-concussion syndrome.
  • McGeown, J., et al. (2018). HDEC 18/NTA/108 Investigating gender differences and the clinical utility of objective neurophysiological measures for sports-related mTBI.
  • Hume, P. A. and S. Kolose (2018). AUTEC 14/126 NZDF anthropometry Survey: Variations in kinanthropometry and implications for the New Zealand Defence Force.
  • Hume, P. A., King, D. et al. (2019 under review,). AUTEC 19/98 Validation of a side-line concussion protocol for lay persons.
  • Hume, P. A. and V. Lopez Jr (2019 in progress,). AUTEC # TBD - Injury Risk Factors in USA Rugby 7s Playing Populations.
  • Hume, P. A., et al. (2019 in progress). AUTEC: Profiling neurocognitive function at rest and immediately post-exertion in a healthy, athletic population.